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2. If you are not represented by an attorney, please complete the following information:
4. Your Name*
5. Case/Ticket/Warrant Number(s)*
7. Mailing Address*
9. City*
10. State*
11. Zip Code*
13. E-mail Address*
15. I will notify the North Myrtle Beach Municipal Court of any changes to any information provided.*

    1. I agree
17. Statement of Request
    I hereby request a jury trial on the above charges. I understand that, if I fail to appear for the Jury Roster Call, at the dates and times to be set at the Jury Roster Call for jury selection, and my trial date, I will be considered to have waived my right to a jury trial and will be tried in my absence before a judge sitting without jury. I further understand that if I am found guilty in my absence, a sentence will be imposed and enforced as soon as I am arrested. A Bench Warrant will be issued for my arrest and/or any bond that I posted will be forfeited. All conditions of my bond shall remain in effect until the jury trial is completed or the charges against me are disposed of otherwise.
19. Electronic Signature*
20. Signature Date*
    Signature Date
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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