Who can use this public assistance infraction declaration?

A registered vehicle owner receiving qualifying public assistance may use it to request reduced penalties for a first automated traffic safety camera violation or a subsequent violation issued within 21 days of the first.

What information does the declaration request?

It asks for the ticket and vehicle details, information confirming public assistance eligibility, and the signer’s name, signature, date, address, phone number, and email.

Fife, WA · Pierce County

No notary required

Declaration of Receipt of Public Assistance Photo Infraction

Vehicle owners receiving qualifying public assistance use this declaration to request reduced penalties for an eligible automated traffic safety camera violation.

$First page of the Declaration of Receipt of Public Assistance Photo Infraction$

What this form is

The declaration is for a registered vehicle owner requesting reduced penalties for a first automated traffic safety camera violation, or a subsequent violation issued within 21 days of the first. It asks the signer to declare eligibility based on qualifying public assistance, identify the vehicle and infraction, and provide contact information. The signer certifies the information as true and correct under penalty of perjury.

Who needs it

A registered vehicle owner receiving qualifying public assistance may complete this declaration when requesting reduced penalties for an eligible camera violation.

How to submit it

Send the declaration to Fife Municipal Court at 3737 Pacific Highway E, Suite 100, Fife, WA 98424, or fax it to 253-926-5435.

About notarization

This document is signed without a notary; the signer certifies the declaration under penalty of perjury and signs and dates it.

How to submit this form

1
Download the Declaration
Download the Declaration of Receipt of Public Assistance Photo Infraction.
2
Complete the Declaration
Provide the requested infraction, vehicle, eligibility, and contact information.
3
Sign and Date
Sign and date the declaration, certifying its contents under penalty of perjury.
4
Submit to Fife Municipal Court
Send the completed declaration to the court’s listed address or fax number.

Frequently asked questions

Who can use this public assistance infraction declaration?: A registered vehicle owner receiving qualifying public assistance may use it to request reduced penalties for a first automated traffic safety camera violation or a subsequent violation issued within 21 days of the first.
What information does the declaration request?: It asks for the ticket and vehicle details, information confirming public assistance eligibility, and the signer’s name, signature, date, address, phone number, and email.
Do I need a notary for this declaration?: No. It does not require notarization. The signer certifies the declaration under penalty of perjury and signs and dates it.
How do I submit the declaration?: Send it to Fife Municipal Court at 3737 Pacific Highway E, Suite 100, Fife, WA 98424, or fax it to 253-926-5435.

Need something notarized?

This Declaration of Receipt of Public Assistance Photo Infraction doesn’t need a notary — but if you have another Fife form that does, a commissioned online notary can help.