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3. Township of Bloomfield
   1 Municipal Plaza Bloomfield, NJ 07003 Telephone (973) 680-4078 Fax (973) 680-4082 bloomfieldcourt@bloomfieldtwpnj.com
5. Wilfredo Benitez
   Chief Municipal Court Judge
6. Vincent A. Pirone
   Judge Municipal Court
9. Claudia Santos
   Court Administrator
11. COURT DATE REQUEST FORM
12. Date
    Date

    Date
14. First Name
15. Last Name
17. Address
19. City
20. State
21. Zip Code
23. Phone Number
24. Fax Number
26. Email Address
27. Ticket # / Complaint #*
29. Please Select one:*

    1. Request a Court Date
    2. Request adjournment
    3. Request Plea by Mail

    (the following violations DO NOT qualify for PLEA BY MAIL request: 39:3-40, 39:4-50, 39:4-96, 39:6B-2, 39:4-97 if accident, 39:4- 49.1).
30. If you need assistance, please contact us at (973) 680-4078.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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