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IN THE MUNICIPAL COURT OF THE CITY OF (City of Lebanon)

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IN THE MUNICIPAL COURT OF THE CITY OF LEBANON
LINN COUNTY, OREGON
CITY OF LEBANON, )
) Docket No.:________________________
Plaintiff, ) Charge(s) :________________________
) ________________________
vs. ) ________________________
)
________________________________, )
) TRIAL BY AFFIDAVIT
Defendant. )
STATE OF _____________ )
) ss.
County of ______________ )
I, _________________________________, have pled NOT GUILTY and hereby waive my
right to trial by personal appearance in Court and submit my evidence by this affidavit to the
Court.
I understand that this affidavit must be submitted to the Court not later than the date and time
of my trial or appearance date in this matter. I understand that the Court may take one or more
of the following actions if I fail to return this affidavit on or before said date and time:
■ Enter a default judgment and a fine based on the citing officer’s
affidavit and my driving record. The fine could be the maximum fine
allowed ; and/or
■ Request that the Motor Vehicles Division suspend my right to
drive in Oregon as provided by ORS 809.220; and/or
■ Forfeit any bail I may have posted.
I understand that I will be notified by mail of the Court’s findings.
The testimony that I wish to submit for consideration by the Court is as follows:
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I swear/affirm that the above-stated facts are true to the best of my knowledge.
Dated: ________________________ _______________________________________
Signature
_______________________________________
Mailing Address (Please Print or Type)
_______________________________________
City State Zip
State of _________________ )
) ss.
County of _______________ )
SUBSCRIBED AND SWORN to before me this _______ day of _______________________.
________________________________________
Notary Public
My Commission Expires:___________________
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IN THE MUNICIPAL COURT OF THE CITY OF (City of Lebanon)

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Completed 19 February 2021

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