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Good Cause Form
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Administrative Review - Good Cause
Cases to be considered?
Please grant the following request(s):
Remove the FTA(s)
Set case on time-payment plan
Reschedule my court hearing
Remove case(s) from collections
Ability to Pay hearing
Other (describe below)
If "other" was selected above, describe here.
Statement of defendant:
After completing the above, please READ and ELECTRONICALLY SIGN, below.
I certify under penalty of perjury under the laws of Washington State that I have read the foregoing statements in the application, know the contents thereof, and believe them to be true and correct. (Perjury is a criminal offense-see Chapter 9A.72 RCW).
Electronic Signature Agreement
I agree. Electronic Signature.
By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Electronic Signature of Defendant
Last name, first name, middle initial
City where electronically signed:
State where electronically signed:
COURT USE ONLY - Judge's Notes
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