"District Court Affidavit Form" - City of Alexandria, Virginia

District Court Affidavit Form is a legal document that was released by the Department of Finance - City of Alexandria, Virginia - a government authority operating within Virginia. The form may be used strictly within City of Alexandria.

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Download "District Court Affidavit Form" - City of Alexandria, Virginia

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DEPARTMENT OF FINANCE
Citation Processing Center
P.O. Box 1423
Phone 866.353.0454
Alexandria, Virginia 22313
Fax 866.219.4908
Dear Sir or Madame,
You have requested a court date to contest a parking citation which will require completion of
the District Court Affidavit.
Please observe the following rules when completing the affidavit. Improperly completed
affidavits will be returned unprocessed:
 Once you schedule a court hearing, you forfeit your ability to prepay the ticket and your
request cannot be removed or adjusted by the Finance Department.
 Affidavits must be completed by the registered vehicle owner.
 The completed affidavit must be returned within ten (10) business days.
 If you cannot appear on your assigned court date, contact the General District Court at
703.746.4041. The Court will decide what course of action you must take.
 If the citation is upheld, you will be assessed the original fine and any court costs.
Please mail the completed, signed and notarized affidavit with a copy of your driver’s license to
City of Alexandria, PO Box 1423, Alexandria, VA 22313-1423
Upon receipt of the completed affidavit, the hearing scheduling staff will process your request.
Court dates are assigned based on officer availability. On the date of your hearing you will be
required to appear at the Alexandria General District Court, at 520 King Street, Room 201,
Alexandria, Virginia 22314.
A verification of the court date will be mailed to the registered owner of the vehicle at the
address listed on the affidavit. If you have questions regarding the affidavit, please call
866.353.0454.
Sincerely,
Citation Processing Center
Enclosure
DEPARTMENT OF FINANCE
Citation Processing Center
P.O. Box 1423
Phone 866.353.0454
Alexandria, Virginia 22313
Fax 866.219.4908
Dear Sir or Madame,
You have requested a court date to contest a parking citation which will require completion of
the District Court Affidavit.
Please observe the following rules when completing the affidavit. Improperly completed
affidavits will be returned unprocessed:
 Once you schedule a court hearing, you forfeit your ability to prepay the ticket and your
request cannot be removed or adjusted by the Finance Department.
 Affidavits must be completed by the registered vehicle owner.
 The completed affidavit must be returned within ten (10) business days.
 If you cannot appear on your assigned court date, contact the General District Court at
703.746.4041. The Court will decide what course of action you must take.
 If the citation is upheld, you will be assessed the original fine and any court costs.
Please mail the completed, signed and notarized affidavit with a copy of your driver’s license to
City of Alexandria, PO Box 1423, Alexandria, VA 22313-1423
Upon receipt of the completed affidavit, the hearing scheduling staff will process your request.
Court dates are assigned based on officer availability. On the date of your hearing you will be
required to appear at the Alexandria General District Court, at 520 King Street, Room 201,
Alexandria, Virginia 22314.
A verification of the court date will be mailed to the registered owner of the vehicle at the
address listed on the affidavit. If you have questions regarding the affidavit, please call
866.353.0454.
Sincerely,
Citation Processing Center
Enclosure
To the Director of Finance for the City of Alexandria, Virginia:
I, ___________________________________________, do hereby certify that I am the registered owner of a _________________________________,
(Name)
(Vehicle Year/Make/Model)
bearing license plate _______________________, for which parking citation number ___________________ for violation code _________________was
(State/License Plate Number)
issued on _________________.
(Date)
I hereby waive formal service of process, request that this matter be set for trial in the Alexandria General District Court (520 King Street, Room 201), and
agree to be present for trial as scheduled.
I understand that if I cannot be present I must call the court at 703.746.4041 to reschedule. I also understand that payment of the fine will NOT excuse me
from appearing in court.
__________________________ _____________________________________________________________
Name
Mailing Address (Street, City, State, Zip)
___________________________
________________________________
___________________________
Driver’s License State/ Number
Phone Number
Email Address
__________________________________________
________________________________
Signature
Date
For Notary Use Only
State/Commonwealth of ___________________
[ ] City [ ] County of ____________________
Subscribed and sworn to/affirmed before me this ______ day of ______________, 20____, by
_______________________________________.
(Print Name of Affiant)
My Commission expires: _____________________ Commission # _____________________
___________________________________
____________________
(Notary Public)
(Date)
For City Use Only
The above named person appeared before a Notary and made oath to the truth of the above statements. As an authorized agent of the Director of Finance for
the City of Alexandria, I hereby request, on behalf of the City of Alexandria, that you schedule a hearing for the vehicle owner listed above on the ____ day
of _________________, 20___ at 9:30 a.m. and subpoena ____________________________________________as a witness in this case.
__________________________________
___________________
(Signature)
(Date)
For Court Use Only
Attorneys Present: ___________________________________________
___________________________________________________________
(Defendant’s Attorney’s Name)
The Accused was this day:
And was tried and found by me:
No attorney
Attorney waived
Tried in absence
Not guilty
Present
Guilty as charged
Guilty of _______________
I impose the following disposition:
Plea of accused:
Finding sufficient/deferred
Fine of $___________ with $___________ suspended
Not Guilty
I order:
Nolo Contendere
The charge dismissed
Guilty
A nolle prosequi on
___________________________________________________________
prosecution’s motion
Judge
Date
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