THE MUNICIPAL COURT OF RENTON

THE MUNICIPAL COURT OF RENTON

DECLARATION OF NON-RESPONSIBILITY

Traffic Camera Enforcement Program

Infractions generated by traffic cameras will not appear on any Department of Licensing driver record.

Notice No:_______________________ License Plate No:______________ State:______

In the spaces above, you must accurately write the 13-digit Notice Number that appears in the box in the upper right of the front of the Notice of Infraction and the license plate number and state for the vehicle involved in the infraction. If the Notice of Infraction number is unclear or incorrect, the Court will not be able to match your declaration to your infraction, and the infraction will go to a collection agency if not paid.

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I declare under penalty of perjury under the laws of the State of Washington that the information provided in this declaration is true and correct to the best of my knowledge:

I received the Notice of Infraction, number listed above. At the time of the violation indicated in the Notice of Infraction, the vehicle described in the notice was:

Stolen (enclose a copy of the police report) Sold to another person who is listed below (enclose a copy of the Seller's Report): In the care, custody or control of another person who is listed below:

Actual Driver's Name: ________________________________________________________________

Driver's Date of Birth: ________________________________________________________________

Driver's Address: ____________________________________________________________________

Street

City

State

ZIP

___________________________________________________________________________________

Your Signature (Declaration is not valid if not signed)

Date

___________________________________________________________________________________

Print your name

Your telephone number

Your email address

___________________________________________________________________________________

Your street address

City

State

ZIP

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Return this completed and signed declaration to the Renton Municipal Court by the due date that appears on the front of the Notice of Infraction. You may deliver or mail the declaration to the Renton Municipal Court at 1055 South Grady Way, Renton, WA 98057, fax it to 425-430-6544 or email at rmcourt@. Mailed declarations must be postmarked on or before the due date.

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