Cowlitz County District Court


If you wish to submit an electronic written statement in lieu of appearing for a mitigation hearing, please use this form. A mitigation is only if you admit that you committed the infraction and would like to explain the circumstances to the judge. The court must receive this form within 15 days from the date the infraction was issued. If you have already requested a hearing this form must be received before your pending court date. You will receive a response by email, so you must provide the court with a valid email address.
If there is an error submitting this form please email your statement directly to:
Please include:  your name, date of birth, and citation number with your emailed statement. 

If you were cited with a moving violation, you may qualify for the infraction deferral program. Please follow this link and review before submitting your statement.

 Personal Information

Last Name:
First Name:
Date of Birth:
Driver's License:


Zip Code:
Ticket Number:


 I certify [or declare] under penalty of perjury under the laws of the State of Washington that the foregoing is true:  I promise that if it is determined that I committed the infraction for which I was cited, I will pay the monetary penalty authorized by law and assessed by the court.
If you agree to the above statement you must type "accept" here   

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