63rd District Court

Request for Informal/Formal Hearing

PEOPLE

___________________________
Citation Number

REQUEST HAS BEEN MADE FOR:

 ___ Informal Hearing

 ___ Formal Hearing

____________________
Date

 VS

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Defendant

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Street Address

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City,  State,  Zip

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Daytime Phone Number

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Home Phone Number

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Signature of Defendant or Representative

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Deputy Clerk / Magistrate