2. City of Gig Harbor, Plaintiff, v.
4. Defendant*
5. Case No.
7. Physical Address*
9. City
10. State
11. Zip Code
13. Mailing Address (if different from physical address)
15. City
16. State
17. Zip Code
19. Primary Phone Number*
20. Message Phone Number
22. Email Address
24. Do you rent, lease, or own your home?*

    1. Rent
    2. Lease
    3. Own
25. How long have you lived there?*
29. My employer is:
31. Employer's Address:
33. City
34. State
35. Zip Code
37. My School is:
38. Location of School:
40. How long have you been with that employer/school?
44. Are you:*

    1. Married
    2. Divorced
    3. Single
45. Drivers License Number:
46. Date of Birth:*
    Date of Birth:
50. Who is the person most likely to know where you are at all times, other than your spouse?
52. What is their address?
54. City
55. State
56. Zip Code
58. Phone Number
60. I have the following family members in the community:
64. READ THE FOLLOWING INFORMATION VERY CAREFULLY AND PAY ATTENTION TO IT, THEN SIGN THE FORM AT THE BOTTOM
66. The information you have provided in this form will be used by the Court for providing notice to you of the proceedings in your case. If you move or if you change your phone number, you must notify the Court immediately. If you do not, it is a violation of your release and you may be arrested.
68. UNDER PENALTY OF PERJURY, I certify that the above information set forth by me is true and correct to the best of my knowledge.*

    1. I agree.
70. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
72. Electronic Signature*
73. Date*
    Date
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field