One-Time Waiver of Citation

First Name

Middle

Last Name

Date of Birth

Address

Address 2

City

State

If address is located outside of the United States or Canada, please select “other” and fill in.

ZIP

Country

Phone Number

Confirm email

Citation Number

Citation Number should start with a "Z" followed by 6 digits.

Date of Violation

Violation Type

Please mark the violation code listed on your citation (must be only one (1) of the following violations). Where are violations listed? Click here for an example.

MTS Ordinance 2/Pub. Util. Code 120450

Penal Code 640(c)(1)

Penal Code 640(c)(2)

How would you like to be notified if your citation is dismissed?

Mail

Certification

I certify to the best of my knowledge that the information on this form is true and correct.

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