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2. Citation No.
3. Plea*
   -- Select One --I plead Nolo ContendereI plead GuiltyI plead Not Guilty and request a trial by juryI plead Not Guilty and request a trial by the court/judge
5. First Name*
6. Last Name*
8. Mailing Address*
9. Physical Address (If Different than Mailing Address)
11. City*
12. State*
13. Zip Code*
15. Contact Phone No.*
16. Email Address*
18. Attorney's Name (If Represented)
19. Attorney's Phone No.
21. Note: If you will be represented by counsel, make sure the court is provided with a "Letter of Representation" from your attorney.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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