New Submission

I have outstanding legal financial obligations (LFOs) in Edmonds Municipal Court for which I am petitioning for relief.

Please answer the following questions.

Are you currently in jail or prison AND have criminal charges in this court with outstanding LFOs??*

YesNo

Do you have more than one case in Edmonds with outstanding LFOs?*

YesNo

Case Number:*

Please list only one case number here.

Additional Case Numbers:

Separate each case number with a comma.

First Name*

Last Name*

Date of Birth

Address*

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Email

The final ruling will be sent by email if provided.

I am requesting the Court:

Select all that apply

Pull balance from collectionsWaive accrued interestAllow monthly payments in the amount indicated belowWaive all non-mandatory LFOsAllow satisfaction of LFOs through Community Service HoursReduce LFOs

I can make monthly payments of:

$

Community Service Acknowledgement:

I understand that all community service reports must be presented on official stationary of the nonprofit organization or corporation, along with the supervising person's name and telephone number. The form must include the hours and dates of the community service performed and documentation that the performed hours are being verified/submitted for only Edmonds Municipal Court and no other court. Community service hours performed for any other court may not be credited towards your LFOs at Edmonds Municipal Court.

Community Service Hour Rate

I understand that if the Court grants my request for community service, the Court will credit my LFOs at the current State minimum wage rate only after submitted hours are verified by the Court. I also understand that Court-ordered restitution will NOT be reduced for community service hours.

I am indigent because I receive:

Current Income Status:

Please describe your income source, list your annual household income and household size. If you are employed, please include your 1) occupation, 2) employer, 3) hours worked per week and how long you have been employed. If not employed, please briefly explain why.

List your recurring basic living expenses:

Additional Statements

Verification Agreement:

I understand the Court may require verification of the information provided above. I authorize Washington State Department of Social and Health Services (DSHS) to release data pertaining to my receipt of public assistance benefits to the Edmonds Municipal Court. I understand that the Court may use the data it receives from DSHS to verify the information provided above.

Please upload any supporting documentation (i.e. W2, recent pay stubs . . .)

Court can ONLY accept documents in the following formats: DOC, PDF, JPG, TIFF

Drop files here

I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing statements are true and correct:

Signature*

Date

Date will be captured on form submission

Time

Time will be captured on form submission

Petition for Outstanding Legal Financial Obligations Relief