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2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Email Address*
    Please include an email address to received the court's answer to your request.
13. Citation/Ticket Number*
15. Currently Scheduled Hearing Date*
17. Reason For Request of New Court Date*
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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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