CONSENT TO VIDEO COURT APPEARANCE
IN THE 21ST JUDICIAL CIRCUIT, ST. LOUIS COUNTY, MISSOURI
UNIVERSITY CITY MUNICIPAL DIVISION

CITY OF UNIVERSITY CITY
vs.

Defendant Name*

Ticket Number(s)*

Email Address*

Address*

City*

State*

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Zip Code*

Phone Number*

Waiver of Right to be Physically Present and Consent to Video Appearance

Acknowledging that I have been advised that I may be entitled to be personally present in connection with the above case and acknowledging that I have been given adequate opportunity to consult with legal counsel concerning the matter, I hereby waive any right to be personally present and consent to a video proceeding.

Signature Acknowledgement*

By entering your initials below, you agree and acknowledge that 1) this form will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

I Agree (First and Last Initial)*

Defendant's Signature*

Date*

Attorney for Defendant, if represented

This Court accepts this waiver, finding that the person waving his or her right has been adequately advised concerning his or her right to be personally present in this case, has waived any right to be personally present, and consents to a video proceeding.