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2. First Name*
3. Middle Initial
4. Last Name*
6. Drivers License Number*
   Full number from your license
8. Court Date
   Court Date

   Court Date
   Court records are often available on the MyCase website.
9. MyCase
   MyCase Court Records
11. Type of Violation(s)*
    What was the ticket for?
13. UTT #
    Number found in the upper right of your traffic ticket document.
14. 
16. Phone number*
18. Address1*
20. Address2
22. City*
23. State*
24. Zip*
26. E-Mail Address*
28. Your submission will be responded to within five (5) business days. This call will determine if you are eligible to enroll in the deferral program.
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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