Request For Accommodation By Person With Disability
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Request For Accommodation By Person With Disability Form. This is a Oregon form and can be use in Tillamook Local County.
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Tags: Request For Accommodation By Person With Disability, Oregon Local County, Tillamook
Tillamook County Circuit Court
Request for Accommodation by Person with Disability
Applicant (name):
Person submitting request (name if different from applicant):
Applicant Address:
Contact Phone Number:
1. Name of proceeding(s) to be covered:
2. Date(s) of proceeding(s):
3. Case Number (if applicable):
4. Applicant is: G Party
G Witness
G Juror
G Attorney
G Other (specify) ___________
5. Type of disability needing accommodation:
6. Type of accommodation needed or preferred:
Date: _____________________
......................................................................
(Type or print name)
____________________________________
(Signature of applicant)
As soon as possible, or at least four judicial days prior to the proceeding, submit this form to:
Trial Court Administration, Tillamook County Circuit Court, 201 Laurel Ave, Tillamook, OR 97141
Phone: 503.842.2596
Fax: 503.842.2597
Revised 6/8/05
American LegalNet, Inc.
www.USCourtForms.com
