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2. Ticket / Complaint Number*
4. Defendant's First Name*
5. Defendant's Last Name*
7. Defendant's Email*
9. Defendant's Phone*
11. Reason for Request*
    -- Select One --COVID-19Exposure to COVID-19Compromised Immune SystemAway in CollegeLives Out of State
13. Address*
15. City*
16. State*
17. Zip Code*
19. Do you need an interpreter?

    1. Yes
    2. No
21. Enter Your Initials*

    Entering your initials signifies that you have read, and understand the rules for Fayetteville's Virtual Municipal; Court session.

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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