Fillable Request For Mandatory Driving Safety Course Form printable pdf download

Case No. _____________

STATE OF TEXAS

In the Justice Court

vs.

Precinct ____

________________________________

Chambers County, Texas

REQUEST FOR MANDATORY DRIVING SAFETY COURSE

Now comes the above named Defendant in this matter and requests that further proceedings be

deferred for ninety (90) days to allow Defendant to complete a Driving Safety Course, under article 45.0511

CCP, approved by the Texas Education Agency. After being by me duly sworn, Defendant on oath deposes

and says:

 I hereby waive my right to a jury trial and enter a plea of

GUILTY or

NO CONTEST to the

charge of _________________________________.

 I have a valid Texas Driver’s License or Permit; or am a member, or the spouse or dependent child of

a member of the United States Military forces serving on active duty; and I am 17 years of age or

older.

 I do not have a Commercial Driver’s License.

 I have proof of financial responsibility (automobile liability insurance).

 I am not in the process of taking a Driving Safety Course for a different traffic offense.

 I have not taken a Driving Safety Course within the past 12 months to obtain dismissal of a traffic

offense.

I understand that I must:

 Pay $110.00 to the Court on the date of my request (or within 10 days if by mail).

 Provide proof of financial responsibility to the Court.

 Present the Certificate of Completion of an approved Driving Safety Course; and

 Present a certified copy of my driving record from the Texas Department of

Public Safety by the given due date. ( )

I further understand this offense will be dismissed after the ninety (90) day period upon providing proof of

successful completion of a Driving Safety Course, certified copy of Driving record and proof of liability insurance.

Failure to take the course or to give the Court my certificate of completion along with my Texas Driving

record by the required due date, will require my appearance to show cause why proof was not timely submitted. At

that time, the Court may enter a judgment of guilt. If I fail to appear at the hearing, the Court will enter a judgment of

guilt and the offense will appear as a conviction on my driving record, plus a Warrant will be issued for my arrest and

additional fine and fees will be assessed.

Date signed:_______________________, 20____

Defendant signature:____________________________________________

DL:___________________________

Address:______________________________________________________

Date/Birth:_____________________

City:___________________________ ST:_________ Zip:____________

Phone:________________________

Email:________________________________________________________

Other:_________________________

SUBSCRIBED AND SWORN TO BEFORE ME, THIS ______ DAY OF ______________________, 20_____.

____________________________________________

NOTARY PUBLIC

Request For Mandatory Driving Safety Course Form

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