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2. Court*

   1. Puyallup
   2. Milton
3. Case Number/s or Infraction Number/s (photo)*
5. Name*
6. Email Address*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number
16. STATEMENT OF DEFENDANT: I am the defendant in the above case requesting the following relief:*

    1. Removal of my case from collections & option for payment plan
    2. Request new hearing date
    3. Request bench warrant quash hearing
    4. Other

    Please submit the Payment Plan Request and/or Fine Reduction form for cases NOT in collections.

18. Statement or Additional Information:
20. Upload Supporting Documentation
22. I certify under penalty of perjury of the laws of the State of Washington that the statements I am submitting to the Court are true and correct to the best of my knowledge.
24. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature*
27. Date Submitted*
    Date Submitted

29. Please allow 2-3 weeks for processing.  You may contact the court at (253) 841-5450 or Courts@PuyallupWA.Gov with any questions.

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field