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Electronic Mitigation Hearing
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Judge's Order area above is for Internal use only.
Citation or Infraction number
Driver's Lic. Number
Full Name Example: Joe Smith
Date of Birth
Date of Birth
Example: (555) 555-5555
If the address provided in the following fields differs from the one listed on the citation, please check this box.
If you would like the court to consider your statement before making a decision, please explain your version of the incident above. Please limit your response to 400 words or 1800 characters.
I hereby state as follows:
I promise to pay the monetary penalty authorized by law or, at the discretion of the court, and reduced penalty that may be set.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
I understand that if this form is submitted electronically, my typed name on the signature line will qualify as my signature for purposes of the above certification.
I have read and accept all of the conditions noted above.
Place Signed / Submitted
Physical location of where you are when submitting this form.
Please type in your name.
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