State v Blake

2. Instructions

   Once an Order Vacating Conviction and Dismissal is signed by the court and filed, you may request a refund of any previously paid LFO's. Below are the steps and additional information needed by the clerk to process your refund application.

   Step 1: Complete the application 

   Step 2: Provide Proof of ID 

   A copy of 1 of the following: (must be valid with photo) 

   • Driver’s License, Instruction Permit, or state-issued ID Card

   • Valid Washington State Temporary Driver’s License

   • U.S. Armed Forces I.D. Card

   • Merchant Marine I.D. Card issued by the U.S. Coast Guard

   • Official Passport, Passport Card, NEXUS Card

   • Washington State Tribal Enrollment Card (No expiration date required)

   Or 

   A copy of 2 of the following: 

   • Expired WA driver’s license, ID card, or permit

   • Cell phone bill or statement

   • Home utility or service document (bill, statement, hook-up order, etc.)

   • Bank or credit card document (statement, card mailer, etc.)

   • School transcript or report card.

   • DSHS benefits letter (medical, food, etc.)

   • Tribal ID

   • Proof of home ownership (mortgage documents, property tax documents, deed, title, etc.).

   • Selective Service Card

   • Concealed weapons permit from a WA county (license to carry a concealed pistol)

   • Homeowner's or renter's insurance policy

   • Auto insurance policy, declarations page, or binder

   • Consulate ID card or Mexican Federal Electoral card

   • Paycheck or pay stub with the employer's name and phone number or address

   • Washington professional license (nursing, physician, engineer, pilot, etc.)

   • W-2 form from an employer or form 1099

   • Letter attesting residence in alternate housing (e.g., assisted living, college campus, mission, senior housing, shelter, or retirement home) on company letterhead with a phone number that could be used in verification of the facility

    

   *Important* 

   If your name has changed and doesn’t match the defendant’s name on the case(s), you must provide documentation showing your previous and new name. Examples of this are:

   • Certified copy of a court order showing your change of name

   • Certified copy of divorce decree showing the new name or authorizing a name change

   • Marriage certificate (including same-sex marriage certificate) that has been filed with the county or authorized issuing authority and has the control or file number.

    

   Step 3: Submit to the Clerk 

6. First Name*
7. Middle Name*
8. Last Name*
10. Street Number*
11. Street Name*
12. Street Type*
13. Apt #
15. City*
16. State*
17. Zip*
19. DOB*
20. Proof of Identity*
22. Phone Number*
23. Email Address*
25. Refund Eligible Case Numbers*

    List all case numbers that are eligible for refund under State v. Blake

26. • If you don't have a case number, you can locate it two ways:
      1. Search by your name online here: https://odysseyportal.courts.wa.gov/odyportal
      2. Email: Clerk@cowlitzwa.gov 
    • If you have a conviction before 1980 and don't have the case number, please indicate the approximate year and details about the event for the clerk to search for a case number.

30. Subject to the perjury laws of the State of Washington, I hereby certify that the information provided is true and correct and that I am the defendant in the cause number(s) listed above and am entitled to a refund of any LFO's previously paid. 

32. Date (MM/DD/YYYY)*
34. Full Name*
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field