Driving Safety Request Form

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City of Austin Municipal Court
Driving Safety Request
Must be submitted/postmarked no later than the appearance date on your citation – see other
requirements below. Not available to anyone with a commercial driver license or juvenile (16 or under).
More information is available at
Case or Citation Number: _____________________ Date of Request: __________________
Name (as shown on citation – please print): _____________________________________________
_____ Address is correct as shown on the citation; OR
_____ Address has changed to (please print): ________________________________________________________
I hereby enter a plea of “no contest” to the violation of __________________________ (must be a traffic violation)
and waive my right to a jury trial. I request that the Court allow me to complete a Driving Safety Course for this
case. I understand that if I successfully complete the course and other terms as listed below in a timely manner, my
case will be dismissed. If I do not successfully complete the terms of the Driving Safety, I will be mailed a notice to
appear in court to show cause why I did not complete the terms. If cause is not sufficient, I understand that the
Driving Safety will be revoked, a judgment of guilt entered, and the conviction will be reported to the Department
of Public Safety to be placed on my driving record. I understand that I have 90 days to take the course and submit
both the certificate of completion and a copy of my driving record to the court as indicated below.
I understand that I have 90 days after the processing of this request by the court to submit to the court:
1.
Take an approved driving safety course and submit the original “court copy” of the certificate;
2.
Obtain a copy of your driving record (version 3 or 3A) from Texas Department of Public Safety.
Date request is processed may be seen online at
Affidavit for Driving Safety
I SWEAR OR AFFIRM that I am not in the process of taking a Driver Safety Course or Motorcycle Operator's Training
Course, if applicable, and that I have not completed a Driver Safety Course or Motorcycle Operator's Training
Course, as applicable, to have a case in any court in the State of Texas dismissed and no such course will appear on
my driving record has having been completed within the last 12 months preceding the date of this offense.
Sworn before me this______ day of __________, 20____.
______________________ or ___________________________________
__________________________
Signature of Defendant
Notary Public in and for the State of Texas
Deputy Court Clerk
My Commision Expires:____________
DO NOT TAKE A DRIVING SAFETY COURSE BEFORE SUBMITTING THE FOLLOWING TO THE AUSTIN MUNICIPAL
COURT :
1.
This document requesting to take a driving safety course (notarized or brought to one of our locations);
2.
Proof of valid vehicle insurance policy or other form of financial responsibility;
3.
Copy of valid non-commercial Texas driver license (unless in the military);
4.
Check for $113.00 or $138.00 if the offense happened in a school zone.
Version: July 2014

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