#RemissionNow Submission Form
Please fill this form out and someone from the team will reach out about next steps
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you filed for clemency or pardon?
No
Yes
If yes, what is your case number?
If no, would you like to apply
Yes
No
What district court is your case in?
How much is your restitution, fines and/or fees?
Do you give The LOHM permission to contact you about your submission?
Yes
No
Submit
Should be Empty: