District Court Affidavit - City Of Alexandria Page 2


To the Director of Finance for the City of Alexandria, Virginia:
I, ___________________________________________, do hereby certify that I am the registered owner of a _________________________________,
(Vehicle Year/Make/Model)
bearing license plate _______________________, for which parking citation number ___________________ for violation code _________________was
(State/License Plate Number)
issued on _________________.
I hereby waive formal service of process, request that this matter be set for trial in the Alexandria General District Court (520 King Street, Room 201), and
agree to be present for trial as scheduled.
I understand that if I cannot be present I must call the court at 703.746.4041 to reschedule. I also understand that payment of the fine will NOT excuse me
from appearing in court.
__________________________ _____________________________________________________________
Mailing Address (Street, City, State, Zip)
Driver’s License State/ Number
Phone Number
Email Address
For Notary Use Only
State/Commonwealth of ___________________
[ ] City [ ] County of ____________________
Subscribed and sworn to/affirmed before me this ______ day of ______________, 20____, by
(Print Name of Affiant)
My Commission expires: _____________________ Commission # _____________________
(Notary Public)
For City Use Only
The above named person appeared before a Notary and made oath to the truth of the above statements. As an authorized agent of the Director of Finance for
the City of Alexandria, I hereby request, on behalf of the City of Alexandria, that you schedule a hearing for the vehicle owner listed above on the ____ day
of _________________, 20___ at 9:30 a.m. and subpoena ____________________________________________as a witness in this case.
For Court Use Only
Attorneys Present: ___________________________________________
(Defendant’s Attorney’s Name)
The Accused was this day:
And was tried and found by me:
No attorney
Attorney waived
Tried in absence
Not guilty
Guilty as charged
Guilty of _______________
I impose the following disposition:
Plea of accused:
Finding sufficient/deferred
Fine of $___________ with $___________ suspended
Not Guilty
I order:
Nolo Contendere
The charge dismissed
A nolle prosequi on
prosecution’s motion


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Page of 2