2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Date of Birth *
12. Phone Number *
14. Email Address*
16. Preferred Method of Contact *

    1. Telephone Number (listed above)

    1. Email
18. For the hearing, a website link will be sent to you. The Court is using Zoom as the platform. You will need to have audio and video capabilities on your device. Please test your device at https://zoom.us/test if you are unsure if you have these capabilities. Do you have these capabilities available?*

    1. Yes
    2. No
20. Do you need an interpreter?*

    1. Yes
    2. No
21. What language? *
23. Citation Number *
    Enter additional citation/violations below.
24. Date of Citation *
25. Violations*
    Please enter the type of citation that was issued, ex: ran stop sign.
27. Citation Number
28. Date of Citation *
29. Additional Violations
31. Is there anything else you need us to know about your situation that might impact your Zoom session?

    1. Yes
    2. No
33. Please provide details in the box below:
35. Thank You ~ Cedar Hill Municipal Court

    Thank you for your submission. For additional information, questions or comments, please contact us by: Tel: 469-272-2930 or Email: court@cedarhilltx.com

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37. 1. Receive an email copy of this form.
38. Email address

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