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2. Case # (Listed on the Ticket)*

   The Court must receive your statement before your scheduled court appearance date or with your initial response to the ticket. You will be notified by email or mail of the Judge's decision. Any additional documentation must be emailed to the court email at court@bainbridgewa.gov.

3. You may not request a deferred finding if you have a commercial driver's license or were operating a commercial motor vehicle at the time of the infraction.*

   1. I do not have a commercial driver's license in the State of Washington or any other state. I was not operating a commercial motor vehicle at the time of the infraction.
4. You are eligible for a Deferred Finding once every 7 years for a moving violation and once every 7 years for a non-moving violation. Moving violations and non-moving violations are defined in WAC 308-104-160.*

   1. I believe I am eligible for a deferred finding. I understand the Judge will review my driving record to determine eligibility.
6. I understand a deferred finding requires a $200 administrative cost. I also understand that if I fail to pay the $200 administrative fee within 60 days, the infraction will immediately go on my record. *

   1. Yes. I understand and will pay the $200 administrative fee within 60 days of the Judge granting my request for a deferred finding.
7. I understand that if I fail to comply with the requirements of: (1) no traffic infractions, (2) no criminal traffic infractions, and (3) payment of the $200 administrative fee, the Court will find this ticket committed and impose the entire penalty stated on the Notice of Infraction. Any administrative cost that I have paid will not be applied as a credit towards the penalty imposed by the Court.*

   1. I understand the requirements of a deferred finding.
8. I am requesting that the court grant a deferred finding. This means that the court defers the entry of a finding of committed for one year. Provided that I do not commit any traffic infractions or criminal traffic offenses during this one year period, the infraction will be dismissed at the end of the one year period. *

   1. Yes- I understand and would like to request a deferred finding.
10. First Name*
11. Last Name*
13. Mailing Address*
15. City*
16. State*
17. Zip*
19. Email address*
20. Do you agree that the Judge's order may be sent to you by email?*

    1. Yes
    2. No- please mail to my mailing address
22. Phone number (in case the court clerk needs to reach you)*
23. If you are not eligible for a deferred finding, would you like to mitigate the ticket and ask the Judge to consider reducing the fine?*

    1. Yes, I agree I committed the infraction and would like to mitigate if I am not eligible for a deferred finding.
    2. No, I would like to contest the ticket and appear at court for a hearing. Please send me a court date.
25. If I am ineligible for a deferred finding, this is what I want the Judge to know about my ticket for mitigation:*
27. If you are not able to pay a fine within 60 days, please explain how much you can pay a month on a payment plan.
29. Documents Sent to Court Email*

    1. I understand that if I want the Judge to consider any additional documents, photos, etc. I must email those to court@bainbridgewa.gov the same day this submission is sent with my name and ticket number.
31. Certification*

    1. I certify or declare under penalty of perjury under the laws of the State of Washington that the attached statement is true and correct. I promise that I will pay the monetary penalty.
32. Type Your Name*
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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