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2. If you have been incarcerated, you may request credit for time served. To request credit for time served, you must provide proof of incarceration from a jail or prison that includes the dates you were incarcerated.
4. To consider your request, you must enter a plea for the charge(s) for which you are requesting jail credit, if you have not done so already.
6. CHECK ONE PLEA:*

   1. NO CONTEST
   2. GUILTY

   Please be advised your plea of No Contest or Guilty will result in a conviction that will appear on your record.
8. List the charge(s) for which you are requesting jail credit. If you have more than 3 charges you would like considered, please include any additional charges with the supporting documentation being uploaded.
10. STATE VS.
12. Defendant Name *
13. Date of Birth *
15. Phone number*
16. Email address*
18. CITATION/CAUSE NUMBER*
19. VIOLATION CHARGED*
21. CITATION/CAUSE NUMBER
22. VIOLATION CHARGED
24. CITATION/CAUSE NUMBER
25. VIOLATION CHARGED
27. ACKNOWLEDGEMENT OF RIGHTS
29. I hereby enter a plea of No Contest or Guilty to the charge(s) listed above that I had not previously entered a plea for. In doing so, I understand I am waiving my right to a trial.
31. COMPLETE ONE OF THE FOLLOWING:*

    1. I am currently incarcerated
    2. I was incarcerated
33. Location: *
35. Date of Incarceration or Dates Incarcerated *
37. Electronic Signature: *
38. Date*
    Date
40. Phone Number*
41. Email Address*
43. Upload Supporting Documents *
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field