Declaration of (Name) First Name Last Name Docket Number(s) The docket number is not the same as the infraction number listed on your ticket. You must wait to submit this form until the Office of Administrative Hearings has your case and assigns you a docket number. If you submit this form without a docket number, it will not be processed. Please answer all of the questions. Non-Responsibility I have received the above-referenced Notice of Infraction. In accordance with RCW 46.63.075, I hereby declare or affirm that at the time of the violation indicated in the Notice of Infraction, the vehicle described in the Notice was: Stolen Sold In the care, custody, or control of another person 1. Please describe why you believe you are not responsible for the work zone speed camera infraction. Is there any additional information you would like the judge to consider regarding whether you are responsible? No Yes If yes, please describe what that additional information is: Additional Information - PDF Only Upload Maximum 5 files.100 MB limit.Allowed types: pdf. I have attached (number) of pages: I agree and declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form (and any attachments) are true. Submit Leave this field blank
