Electronic Deferred Finding

2. 

   Judge's Order area above is for Internal use only.

4. Citation or Infraction number*

   Include Letters

5. Driver's Lic. Number*

6. Violation Date*
   Violation Date

8. Name*

   Full Name Example: Joe Smith

9. Date of Birth*
   Date of Birth

11. Email*

12. Phone Number*

    Example: (555) 555-5555

14. If the address provided in the following fields differs from the one listed on the citation, please check this box.

16. Mailing Address*

18. City*

19. State/Province*

20. Zip/Postal Code*

21. Country*

23. Statement

    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.

25. 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.<br><br>I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.<br><br>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.<br><br>I have read and accept all of the conditions noted above.

    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.

27. Date*
    Date

    Today's Date.

28. Place Signed / Submitted*

    Physical location of where you are when submitting this form.

29. Signature*

    Please type in your name.

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field