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2. Puyallup *Request for Mitigation

   The local rules of Puyallup Municipal Court allow you to submit a written statement instead of appearing at the hearing. If you wish to submit an electronic written statement in lieu of appearing at the hearing, please use this form. If you currently are scheduled for a mitigation hearing, this form must be received by the Clerk at least THREE (3) BUSINESS DAYS BEFORE THE HEARING. You also must provide the clerk with a valid email address so that the court can follow up with any questions.  NO APPEAL MAY BE TAKEN FROM THE RESULTS.

4. *Request must be submitted to the court within thirty days (30) days from the date that you received your infraction or thirty-three (33) days if ticket mailed by the court.
6. THE COURT WILL ADVISE YOU OF THE RESULTS OF THE HEARING BY MAIL. PLEASE LOOK AT THE INFRACTION NOTICE YOU RECEIVED TO COMPLETE THIS FORM.
8. Ticket Number:*
10. Last Name*
11. First Name*
12. Middle Initial:
14. Date of Birth*
    Date of Birth
15. Phone Number*
16. Text Reminders*

    1. Yes
    2. No

    Data rates may apply.

18. Address*
20. City*
21. State*
22. Zip Code*
24. Email Address:*
26. Statement*
28. Upload Additional Documentation (optional)
30. 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.
32. Electronic Signature*
33. Date*
    Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field