Douglas County Forms

2. Select either Mitigation Hearing or Contested Hearing*

   1. Contested Hearing: I want to contest the infraction(s). I did not commit the Infraction(s)
   2. Mitigation Hearing: I agree I have committed the infraction(s) and I want to explain the circumstances
4. Full Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Date of Birth*
    Date of Birth
14. Phone Number*
16. Ticket Number*
18. Please type your statement:*
20. Yes to Agree*

    1. Yes I agree

    By checking yes, I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I am aware that under the Rules and Codes of the State of Washington governing Infraction law that there shall be no appeal from a decision rendered on written statements. I promise to pay the monetary penalty assessed by the court.
22. 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.
24. Electronic Signature*
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field