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2. Court*

   1. Puyallup
   2. Milton
3. Case Number/s*
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
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
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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