Blake Contact Form

2. First Name*
3. Last Name*
4. Date of Birth*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Email Address
13. Telephone Number
14. Case Number(s)
16. Are you currently on probation/community custody?

    1. Yes
    2. No
18. Is there an active warrant for the Unlawful Possession of Controlled Substance case?

    1. Yes
    2. No

20. I understand the Douglas County Prosecutor’s Office does not represent me in this matter and is prohibited by law from providing legal advice regarding this or any other criminal or civil matter.  I understand that by submitting this Contact Form, I am indicating that I am not currently represented by counsel and am acting pro se (on my own).  I also understand that I am not required to submit this form and alternatively can present matters directly to the Court either through an attorney or as a pro se litigant.  I agree that the Douglas County Prosecutor’s Office is considering my request for relief as a courtesy in the interests of justice and may require that I file a motion for relief with the court at any time.  In some circumstances, I might qualify for counsel (possibly at public expense), but I am choosing to use this form instead.  I understand the Douglas County Prosecutor’s Office will conduct a criminal history check if the relief sought includes resentencing.

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