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Submit Proof of Financial Responsibility (Insurance)

  1. This form allows you to submit proof of insurance in order to dismiss or reduce your citation for Fail To Maintain Financial Responsibility.
  2. If you did not receive a citation for Fail To Maintain Financial Responsibility, this form is not for you.
  3. Failure to complete this form in its entirety will result in an incomplete submission and may not be reviewed.
  4. Were you covered on the date of your violation?*
  5. Your citation would not be eligible for a full compliance dismissal, however, you may be eligible for a $100 reduction if you obtained insurance after you received your citation. Did you obtain insurance after receiving your citation? *
  6. Were you in a company vehicle or personal vehicle at the time of your violation?*
  7. You must provide a copy of insurance that shows the vehicle you were cited in.
  8. You must provide a letter from your employer stating you were in fact employed on the date you received your violation and would have been driving the vehicle you were cited in.
  9. You must provide a copy of insurance that was active on the date you received your violation.
  10. You must provide a copy of insurance showing that you obtained coverage after receiving your violation.
  11. I swear or affirm that the following statements are true:*
  12. Upon submission of this form, your documents will be reviewed by the court staff and you will be contacted by email once a determination has been reached. Please allow up to 3-5 business days for the court staff to review your submission.
  13. Leave This Blank:

  14. This field is not part of the form submission.