Time Served Credit Request Form
Submit your request to have time served credited toward your sentence or penalty.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Case or Reference Number
*
Facility or Location Where Time Was Served
*
Dates of Incarceration or Custody (Start to End)
*
Total Time Served (in days, weeks, or months)
*
Reason for Requesting Time Served Credit
*
Upload Supporting Documents (e.g., release papers, court orders)
Upload a File
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Choose a file
Cancel
of
Signature
*
Submit Request
Submit Request
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