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Request for Administrative Law Judge Hearing

2. Case #:*

3. Citation #:

5. Defendant Name:*

6. Phone:

8. Mailing Address:

10. City:

11. State:

12. Zip:

14. Email:

15. Address of Violation:

17. Description of Appeal:

19. Upload any evidence for the court:

    The form is set for one file. If you have more than one file, such as multiple pictures, please combine into a single zip file or other method. Acceptable formats include, .jpg, .pdf, .docx, .doc, .mp4, .wav, .mov.

20. Special requests

    Any special requests or accommodations that the court needs to be aware of:

22. Provide your name to agree to appear.*

    I hereby request an Administrative Law Judge hearing with Summit County. Summit County will provide a 7 day prior notification of the hearing. Administrative Law Judge Hearings will be scheduled as needed. Hearing will be heard at the County Courthouse, 60 N Main St. Coalville UT 84017.

23. Today's date
    Today's date

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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