Motorcycle Operator Training Course Request Form - Montgomery County

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Driving Safety Course or
Motorcycle Operator Training Course Request Form
Instructions: Complete the attached form, sign and date, attach required copies and/or documents, and a check (no
temporary or out of state checks) or money order/cashier’s check for $110.00 payable to JP 5, and return to the court
on or before your appearance date. When mailing your request, please enclose a Self-Addressed Stamped Envelope.
Special note for Juveniles: A defendant who is under the age of 17 must appear in Court with a parent, guardian, or
managing conservator, to enter a plea and request to take a Drivers Safety Course.
IN THE JUSTICE COURT
MONTGOMERY COUNTY, PCT 5
Cause # _________________________ Ticket # _________________________
The State of Texas vs ________________________________________________
Offense: ___________________________________________________________
I hereby plea No Contest to the above referenced moving traffic citation, and I waive my right to a trial by jury. I
request the Court to dismiss the charges under the terms of Transportation Code Section 543 of the Texas Traffic
laws. I certify and affirm that:
*I have a valid Texas Driver’s License, number ____________;
*I DO NOT hold a commercial driver’s license;
*I have not taken the Driving Safety Course for ticket dismissal within the past twelve (12)
months, nor am I currently taking said course;
*I am not charged with speeding 25 or more mph over the posted speed limit;
*I currently maintain vehicle financial responsibility as required by the Texas Motor Vehicle Safety
Responsibility Act, and have attached proof;
*I have attached a check (no temporary or out of state checks) or money order/cashier’s check in payment of the
state fees, in the amount of $110.00.
Signature: _____________________________________ Date: __________________
Address: ______________________________________________________________
City: ________________________________State____ Zip Code: _______________
Home Phone: __________________Work or Alt .Phone: _________________________

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