ACTS, 1966.—CHAP. 367.
notice shall be made in triplicate and shall contain the name and ad-
dress of the offender, the time, place and nature of the violation, and the
name of the police officer. Upon the completion of his tour of duty
such police officer shall give his commanding officer two copies of such
notice. Said commanding officer shall retain one such copy in his files
and, not later than the next court day, deliver the other copy to the clerk
of the court before whom the offender has been notified to appear. Said
notice to appear shall be printed in such form as the chief justice of the
municipal court of the City of Boston and the chief justice of the dis-
trict courts may prescribe for such courts.
A police officer taking cognizance of any such violation may request
the offender to state his name and address. Whoever, upon such re-
quest, refuses to state his name and address, or states a false name and
address or a name and address which is not his name and address in
ordinary use, shall be punished by a fine of not less than twenty nor
more than fifty dollars. Any such offender who refuses upon such re-
quest to state his name and address may be arrested without a warrant.
Any person notified to appear before the clerk of a district court as
hereinbefore provided may appear before such clerk and confess the
offense charged, either personally or through an agent duly authorized
in writing or by mailing to such clerk, with the notice, the sum provided
herein, such payment to be made only by postal note, money order or
check. If it is the first, second or third offense subject to this section
committed by such person within the jurisdiction of the court in the
calendar year, payment to such clerk of the sum of one dollar shall
operate as a final disposition of the case; if it is the fourth or subsequent
such offense so committed in such calendar year, payment to such clerk
of the sum of two dollars shall operate as a final disposition of the case.
Proceedings under this p