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2. IN THE COUNTY COURT OF THE FIFTH JUDICIAL CIRCUIT, IN AND FOR 
   CITRUS COUNTY, FLORIDA

4. Citation Number*
5. Click Link below to find your Citation Number
   Secured Online Records Search System (SCORRS)
7. Name*

9. AFFIDAVIT

11. I swear that I am not able to provide proof of valid insurance/registration on the vehicle cited in the above case for the following reason: *

    1. The vehicle cited in the above case has been sold.
    2. The vehicle cited in the above case has been stolen or destroyed.
    3. The vehicle cited in the above case is registered in a state which does not issue a certificate of registration (registration violations only).
    4. The owner or registrant of the vehicle is not required by s. 637.733 to maintain personal injury protection insurance (insurance violations only). Check this reason only if your motor vehicle is a sc
    5. The vehicle cited in the above case is owned by another person.
    6. Other
13. If other, please explain below
15. Under penalties of perjury, I declare that I have read the foregoing plea and that the facts stated in it are true*

    Please enter your full legal name in the box above

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17. 1. Receive an email copy of this form.
18. Email address

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