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2. The local rules of Yakima County District Court allow you to submit a written statement instead of appearing at the hearing. If you wish to submit an electronic written statement in lieu of appearing at the hearing, please use this form. It must be received by the Clerk at least 1 court day before the hearing. You also must provide the Clerk with an email address so that the court can advise you about the result of the hearing. No appeal may be taken from the result.
   
   You must have responded to the requirements on the back of the green copy of your ticket and you must have already received a court date from the Court before using this form.
4. Results Preference

   1. Email
   2. Regular Mail

   The court can also advise you of the result of the hearing by return email or regular mail. Please check the box that indicates your preference.
6. First Name
7. Last Name
9. Date of Birth
   Date of Birth
10. Email Address
12. Address
14. City
15. State
16. Zip Code
18. Date of Hearing
    Date of Hearing
19. Ticket Number
21. Statement
23. Certification

    1. I agree

    By checking the box, I hereby certify or affirm under penalty of perjury of the laws of the State of Washington that the foregoing is true. I promise to pay the monetary penalty assessed by the Court.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field