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2. DEFENDANT INFORMATION
4. Defendant First Name*
5. Defendant Last Name*
7. Ticket Number*
8. Violation/Offense*
10. ATTORNEY, if applicable
12. Attorney First Name
13. Attorney Last Name
15. Law Firm Name
17. CONTACT INFORMATION
19. Street/PO Box*
21. City*
22. State*
23. ZIP*
25. Phone Number / Text Number

    In providing your phone/text number, you are agreeing to receive notifications and/or scheduling information about the case.

26. Email Address *
28. Driver's License/Identification
30. I request that the court date be reset for the following reason(s):*
32. Upon receipt, the Judge will review your request to reset and determine how to proceed with your case. If a reset is granted by the Court, you may be notified of the court date by mail or email. It is your responsibility to update your contact information with the Court.
34. Signature*
    By typing my name, I adopt this as my signature and have read, affirm and agree to the information herein.
35. Date*
    Date
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field