Compliance Program Form

Please fill out the form below if you wish to participate in the Compliance Program ("fix-it" offenses).

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FIRST NAME *

LAST NAME *

DATE OF BIRTH

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MAILING ADDRESS *

CITY *

STATE *

ZIP CODE *

CITATION NUMBER *

EMAIL ADDRESS *

PHONE NUMBER *

I understand I must provide acceptable proof of the correction to the court PRIOR to my court date or extension date. *

Agree

Can you provide proof of correction PRIOR to your court date, or do you need an extension? *

I can submit proof prior to the court appearance date/time listed on my citation.

I cannot submit proof prior to my court date and will need an extension to correct the violation.

Additional Comments to Court Staff

Contact Information