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2. Defendant's Name*
3. Case Number*
5. I have received an infraction within the fifteen (15) days and request:

   1. A mitigation hearing to explain the circumstances. I know I can ask witnesses to appear but they are not required to appear.
   2. A contested hearing. I did not commit the infraction. I know I can require witneses, including the officer who wrote the ticket, to attend the hearing.
7. Please send me a court date and I promise to appear either in person on that date, or submit a written statement at least one court day prior to the hearing date. I undertand if "traffic" is checked on the front of the infraction, that this will go on my driving record.
9. Mailing Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Fax Number
18. Email Address
    If you want an email response acknowledging receipt of your hearing request please supply an email address. We will send you a written notice of your court date via mail at the address you have provided.
20. Signature*
    Please type your name here
21. Date
    Date
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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