Court Date Request

TO REQUEST A COURT DATE PLEASE FILL OUT THIS FORM

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Citation Number *

Violation *

Requestor's Name (first and last) *

Date of Birth (mm-dd-yyyy) *

E-mail Address *

Phone Number *

Mailing Address (number, street, city, state, and zip code) *

Are you requesting additional time to pay? *

Yes

Do you wish to contest the alleged violation? *

Yes

Affirmation Signature Agreeing to Terms *

By typing your full name here you are agreeing to the terms and conditions of the DSC request.

Upload photo of form of identification *

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp txt pdf doc docx ppt pptx odp xls xlsx.

Upload photo of driver's license

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp txt pdf doc docx ppt pptx odp xls xlsx.

Proof of Current Liability Insurance

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp txt pdf doc docx ppt pptx odp xls xlsx.

Contact Information