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2. Defendant's Name*
3. Case Number*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Fax Number
14. Email Address*
16. I am requesting a:
    -- Select One --Mitigation HearingContested Hearing
18. Infraction Hearing Written Statement*
    Pursuant to the local court rules for Yakima County District Court, you may submit a written statement in lieu of appearing at either a contested or mitigation hearing on your traffic infraction(s). If you wish to submit a written statement for the Judge to consider in lieu of appearing at the hearing, please use this form. It must be received by the clerk at least one court day before the hearing. No appeal may be taken from the result of the hearing. You may attach photocopies of any documents you believe are relevant to your statement.
20. Upload Additional Documents
22. I hereby certify or affirm under penalty of perjury of the laws fo the State of Washington that the foregoing is true. I promise that if it is determined that I committed the infraction(s) for which I was cited, I will pay the monetary penalty assessed by the Court.
24. Date: *
    Date:
25. Signature*
    Please type your name.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

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