Violation Election Form - State Of Oregon County Of Clatsop Page 2
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1
2I
C
C
S
O
N THE
IRCUIT
OURT OF THE
TATE OF
REGON
C
CLATSOP
FOR THE
OUNTY OF
PO Box 835 Astoria OR 97103
503-325-8555
State of Oregon
Case No:
Plaintiff,
vs.
DEFENDANT’S DECLARATION
Defendant.
(Trial by Declaration)
I waive my right to appear personally at trial and submit my evidence by this Declaration to the court.
I understand that I will be notified by mail of the court’s decision.
Additional page attached
Certificate of Document Preparation. Check all that apply:
I chose this form for myself and completed it without paid help
A legal help organization helped me choose or complete this form, but I did not pay money to anyone
I paid (or will pay)
for help choosing, completing, or reviewing this form
I hereby declare that the above statements are true to the best of my knowledge and
belief. I understand they are made for use as evidence in court and I am subject to
penalty for perjury.
Date
(signature)
Print Name
Contact Address
City, State, Zip
Contact Phone
09/01/2015, 02/2016 DL|ba
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