Fillable Driver Improvement Registration Form (Page 2 of 2) in pdf

WHEN YOU RECEIVE A TRAFFIC TICKET, YOU HAVE THREE CHOICES. YOU MUST ENTER A PLEA (even if bond was posted on the

ticket). PLEASE SIGN AND DATE WHERE PROVIDED AND RETURN THIS ENTIRE FORM AFTER SELECTING ONE OF THE CHOICES

BELOW:

_____ PLEAD NOT GUILTY this form MUST BE RECEIVED IN OUR OFFICE at least THREE (3) working days before the date set for

your first appearance date at the bottom of your ticket. A new appearance date will be set and you will be notified of the time and date

of your trial. Do not come to court until you are notified. I intend to PLEAD NOT GUILTY and request a ________________ Trial by

Judge or a _________________ Trial by Jury (may require a fee).

_____ PLEAD GUILTY AND APPLY FOR COURT SUPERVISION. (This option may not be selected if your ticket is marked “MUST

APPEAR” or YOU ARE UNDER “21”.) Keep a guilty conviction from affecting your driving record by completing the Driver Safety

Program. Your court supervision will be reported but a conviction will not be entered on your record. Complete the Application for

Court Supervision and the Driver Safety Program (see other side) and enclose a payment of $155 or $175 (non-refundable fine and

class fee) payable to the Clerk of the Circuit Court and mail both in the pre-addressed envelope (you may also apply for supervision

for speeding 21-30 miles per hour over the posted speed limit with a non-refundable fine and class fee of $205). Avoid a conviction

On Your Driving Record, Plead Guilty, Register for the Driver Improvement Program. Pay $175, for speeding 21-30 miles over the

limit, pay $155 for speeding 1-20 miles over the limit and all other non-must appear tickets. Place your signature below on the

reverse side and mail in the pre-addressed envelope. DO NOT APPEAR IN COURT.

_____PLEAD GUILTY and pay $120, unless the complaint for speeding is for 21-30 miles per hour over the limit then the fine is $140

or for No Seat Belt the fine is $60, by mail or in person, without going to court (if you are charged with speeding 31 miles per hour

and over the posted speed limit, you “MUST APPEAR” IN COURT). By signing below, I understand my right to a trial, that my signature

to this plea of guilty will have the same force and effect as a judgment of court and that this record will be sent to the Secretary of

State (or the State where I received my license to drive). I hereby PLEAD GUILTY to the said offense on the ticket, GIVE UP my right to

a trial and agree to pay the penalty required.

COURT SUPERVISION AND DRIVER IMPROVEMENT PROGRAM:

an opportunity to prevent your traffic ticket from appearing on your record as a conviction

If you were under 18 years when you were ticketed you must appear in court with a parent or guardian to receive court supervision. If

you were 18-20 years old when you were ticketed you must appear in court.

You are NOT ELIGIBLE for Driver Improvement Program if:

Your ticket is marked “Must Appear in Court”

You are a holder of a CDL license.

Charged with an offense while driving a commercial motor vehicle

If the “URBAN DISTRICT” box on the ticket is checked or if “URBAN DISTRICT” is written on your ticket.

Or your ticket is for one of the following violations:

SPEEDING - SCHOOL ZONE, 625 ILCS 5/11-605(a)

PASSING A SCHOOL BUS, 625 ILCS 5/11-141(a)

SPEEDING - CONSTRUCTION ZONE, 625 ILCS 5/11-605(b)

ALL ILLEGAL TRANSPORTATION OF ALCOHOL 625ILCS 5/11-502(a) OR (b)

PLEA OF GUILTY AND REQUEST COURT SUPERVISION AND DRIVER IMPROVEMENT PROGRAM

Make sure you remit the correct amount and fill out form completely or your application will be returned to you. If you have any

questions contact us at: (815) 434-8271

This form must be received in our office at least 3 working days before your court date

I, ____________________________________________ certify under penalty of perjury, pursuant to 735 ILCS 5/1-109 that the

following statements are true:

I am requesting that the court place me on supervision for the enclosed traffic violation. It does not require me to appear in

court. This ticket will not show as a conviction on my driving record.

I understand that my supervision will last 90 days from the date the LaSalle County Circuit Clerk’s Office receives my “PLEA

OF GUILTY” with the payment of the fines, penalties and costs provided by law. It also requires me to remain without

additional traffic violations during this time.

I have not already been placed on court supervision (either by Judge or by attending a Traffic School Program) for another

traffic ticket that was issued within 12 months of this ticket in any jurisdiction.

I agree to pay the fine for this ticket and the DIP school fee (both are non-refundable) with this application.

I understand that I AM PLEADING GUILTY to the charge on this ticket, I WAIVE my right to a hearing by the court or jury, and

request court supervision.

I agree to complete the Driver Improvement Program within 90 days of the violation

Send proof of completion to our office within 90 days of first appearance date.

I understand my supervision will be revoked and my guilty plea will be used to enter a conviction to the Secretary of state if:

I am found to be ineligible.

I don’t complete the class within 90 days of my violation.

I receive another traffic violation within my supervision period.

REMEMBER: WE MUST RECEIVE YOUR REQUEST AT LEAST 3 WORKING DAYS BEFORE YOUR ORIGINAL COURT DATE.

SIGN HERE:

Signature x ________________________________________________

DIP 9-13

Driver Improvement Registration Form Page 2

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