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2. ** Upon submission of this form, please do not call the Court to schedule a hearing or send in your copy of the signed ticket. You will receive notice of your formal hearing date within 14 days of your request. Complete this request for civil infractions only.
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Daytime Phone Number
14. I am requesting a formal hearing and am waiving my right to an informal hearing.

    1. Yes
    2. No
16. Ticket Number
17. Ticket Issue Date
    Ticket Issue Date
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field