Defendant’s Statement I wish to submit my case to the court in writing. I have read and agree to abide by the rules and procedures governing hearings by mail. I agree to pay any penalty imposed in the time period set by the court. I understand that I can not appeal the court’s decision. Signature: Date: Ticket Number (required): Name: Address: Phone: THE FOLLOWING IS MY WRITTEN STATEMENT CONTESTING MY INFRACTION OR EXPLAINING MITIGATING CIRCUMSTANCES: I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing statement is true and correct. Date and Place (City) Signature KCDCF #88/01& 89/01 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com