Virtual Court Hearing Request Form

Virtual Court Hearing Request Form

This form must be completed by the person that received the citation

ELIGIBLE CASES	NOT ELIGIBLE CASES
All moving traffic violations	Assault - Family Violence
Defective Equipment	Any case in which the prosecutor
Disorderly Conduct	excercised their right to be heard on
Driving While License Invalid/Suspended	the case
Expired Registration
Fail to Change Address on Drivers License
Fail to Maintain Financial Responsibility (No Insurance)
No Driver's License/Expired Driver's License
Possession of Drug Paraphernalia
Public Intoxication
Theft
Minor in Poss/Cons of Alcohol or Tobacco
Driving Under the Influence
Public Intoxication by Minor
Juveniles

Name *

First Name Middle Name Last Name
Date of Birth *

Month Day Year
Date
Driver's License Number *
Driver's License State of Issuance *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone *
Please enter a valid phone number.
Home Phone *
Please enter a valid phone number.
Email Address *
example@example.com
Citation Number *
Offense Charged *
Do you have additional citations? *

Yes No
Citation Number *
Offense Charged *
Do you have additional citations? *

Yes No
Citation Number *
Offense Charged *
Photo of Driver's License

Cancel of
Proof of Liability Insurance

Cancel of
I, verify, under penalty of perjury under the laws of the United States of America, that the above information is true and correct. I understand that any paperwork the Court sends to me will be mailed to the address that I have provided the Court. If my address changes, I will contact the Court by mail or in person to provide the updated information.
Agree to Terms Listed Above *

Yes No
Signature *

Clear
Today's Date *

Month Day Year
Date
Please verify that you are human *
Should be Empty: