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2. If you are needing to ask a question, proceed to the next section below.

4. First Name*
5. Last Name*
6. Date of Birth*
   Date of Birth
8. Phone Number*
9. Citation / Docket Number*
11. Email Address*
13. Please select a Plea option below:*
    -- Select One --GuiltyNolo Contendre (No Contest)Not Guilty I have previously pled to this case
15. Comment*
17. Electronic Signature Agreement *

    By checking the "I agree" box below, you agree and acknowledge that 1) the information you supplied is true and correct, 2) your request will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

    1. I agree
19. Electronic Signature*
20. Date of Signing*
    Date of Signing
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