2. Bartonville Municipal Court Document Submission Form
4. First Name*
5. Last Name*
7. Phone Number*
9. Email*
11. Date of Birth*
    Date of Birth
    Enter in MM/dd/yyyy format - example 01/31/1881
13. Citation Number*
15. DOCUMENT(S) TO SUBMIT
    Attach documents to submit such as application requests, Proof of Insurance, Copy of Driver License, etc.
17. Document 1*
    You must attach a PDF, JPG, PNG Files must be less than 5 MB.
19. Additional Document 1
    You must attach a PDF, JPG, PNG Files must be less than 5 MB.
21. Additional Document 2
    You must attach a PDF, JPG, PNG Files must be less than 5 MB.
23. Additional Document 3
    You must attach a PDF, JPG, PNG Files must be less than 5 MB.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field