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Bonney Lake Municipal Court

9002 Main Street East, Suite 100 Bonney Lake, WA 98391


Judicial/Administrative Review RE: Good Cause Form

Questions should be directed to 253-862-6606

What Court Jurisdiction:

Full Name

Full Address

Statement of defendant: I understand these cases are/may be in Collection Status. Please grant the following requests:

I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

Date Signed

Defendant's Signature

Choose how to sign


** COURT DATE______________ AT ___________ A.M.    P.M.**



Your motion/request is  GRANTED      DENIED


______ Case(s) shall be removed from collections upon proof of clearance of all outside Department of Licensing holds. Outside holds must be cleared within _____________ days.

______ FTA fees shall be waived/reduced to _____________________.

______ No time payment plan is authorized. You must contact Puget Sound Collections at 253-566-1800 to set up payment arrangements.

______ Case(s) shall be removed from collections status and FTA's cancelled upon receipt of initial first payment of $________________ by ___________________.

______ Time payment plan is approved. Monthly payments of $_______________ is due ________________ and continues each month until paid in full. Any missed payment will result in re-referral to collection status and re-issuance of the FTA.



Date ______________      ___________________________________________

                                                        Judge / Pro tem