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2. 
4. First Name*
5. Last Name*
7. Date of Birth*
   Date of Birth
8. Email
10. Address1*
12. Address2
14. City*
15. State*
16. Zip*
18. Case Number*

20. I make the following declaration -

22. 1. Reason for request. I am seeking relief from the infraction judgment entered in this matter for the following reason –*

    1. Failure to Appear. I failed to appear for the infraction hearing. IRLJ 3.2(b)
    2. Mistakenly Identified. I was mistakenly identified as the person who committed the infraction in this matter. IRLJ 6.7(b).
24. 2. Relief Requested. I would like the Court to grant me the following –*

    1. Contested Hearing. I did not commit the infraction. I want a contested hearing.
    2. Mitigation Hearing. I admit I committed the infraction but would like a mitigation hearing so I can explain the circumstances to the judge and/or ask the judge to reduce my penalty.
26. Reason for this request:*

28. I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct, and that I am the person whose name I wrote below.

30. Signed at (city)*
31. (state)*
32. on (date)*
    on (date)
34. Defendants Signature*
36. Order (Office Use Only)

    Defendant's request for relief from judgment is:

    ____Granted                ____Denied

     

    ________________                                       ___________________________

    Date                                                                   District Court Judge

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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