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2. Defendant's Name*
3. Date of Birth
   Date of Birth
4. Upcoming Court Date
   Upcoming Court Date
6. Address*
8. City*
9. State*
10. Zip Code*
12. Phone Number*
13. Email Address*
17. Are you An Attorney?*
    -- Select One --YesNo
18. Have you hired an Attorney?*
    -- Select One --YesNo
20. Attorney Notice of Appearance*
    Please attach your notice of Appearance for your Client
21. Attorney Name *
23. Phone Number*
24. Fax Number*
26. Email Address
28. Attorney's Name*
    Your Attorney must submit a Notice of Appearance to our office, your case will not be scheduled until then.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field