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2. First Name*
3. Middle
4. Last Name*
6. Cell Phone Number*
7. E-mail*
8. Are you waiting in a vehicle?*

   1. Yes
   2. No
9. Vehicle Color and Make/Model (no vehicle - give your location. Example: Parking Lot Bench )*
11. Are you a(n): *

    1. Defendant
    2. Plaintiff
    3. Witness
    4. Attorney
    5. Officer
    6. Juror
    7. Other
12. Case # / Defendant's Name
14. Reason for your visit to the Court (please select)*

    1. Walk-in to clear a warrant
    2. To meet with court appointed attorney
    3. Probation violation/show cause hearing
    4. Reporting to probation
    5. To meet with the prosecutor for a pre-trial hearing
    6. To attend arraignment or pre-hearing
    7. To attend a showcause hearing for failure to pay
    8. To attend landlord tenant hearing
    9. to attend a civil or small claims hearing
    10. To complete sentencing
    11. To pay a ticket or make a payment
    12. Other
15. Please Specify*
17. Payment Options
    Online Payments
21. Self Screening
23. Do you have a fever greater than 100.4 degrees? *

    1. Yes
    2. No
24. Do you have any of the following symptoms: fever, cough, shortness of breath, sore throat or diarrhea?*

    1. Yes
    2. No
26. Do you have any of the following symptoms?*

    1. Fever
    2. Chills
    3. Muscle Pain
    4. Headache
    5. Sore Throat
    6. Recent loss of taste or smell
    7. None of the above
27. Within the last 14 days, have you had contact with an individual diagnosed with COVID-19?*

    1. Yes
    2. No
29. Have you traveled internationally in the last 14 days? *

    1. Yes
    2. No
30. Do you have a face mask or face covering to allow entry into the building?*

    1. Yes
    2. No
32. Temperature (Court to Process)
33. Signature (Court to Process)
35. _______________________
36. _______________________
Leave This Blank:


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

    This field is not part of the form submission.

39. Submit

* indicates a required field