s Date Also complete Section G Other Clog Matters Date Judgment —• Judicial Outman •at Amount Suripenslore Yeas_ months C. Summons Date: ❑Fodeal Duce 0. V.S. Code Violation Required tor section A. 8. F and J (Federal ONy) Tee Scaler R Cann K. Administrative Sanction Date• &bled oeseptien Co