Columbus Municipal Court Driving Offences Options Page 2

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Mail this form, with other items requested, to the Municipal Court shown at the top of the opposite page.

NAME (Print ortype as it appears on your Driver’s License>

Driver’s License Number

Current Mailing Address

City, State, Zip

Telephone Number (Daytime)

Citation No,

Date of Citation

Date cited to appear on or before

Alleged Violation #1 (plea entered below)

Alleged Violation #2 (plea entered below)

CHECK ONE AND CIRCLE: (Under 17 years of age must appear with parent)

I hereby enter a plea of (circle one) GUILTY / NO CONTEST to violation #

(and violation #

and waive appearance for trial. A Cashier’s

Check or Money Order in the total amount of the fine(s) is enclosed.

I hereby enter a plea of (circle one) GUILTY / NO CONTESTto violation #

waive appearance for trial, and request that the Court grant me a

Driving Safety Course (DSC). I have completelyfilled out the DSC request below.

I hereby enter a plea of (circle one) GUILTY / NO CONTEST to violation #, (and violation

#_)

and request that the Court grant me Deferred

Disposition. I have completelyfilled out Section C below.

I hereby enter a plea of NOT GUILTYto alleged violation #

—

(and alleged violation

#_.J

and request the court advise me of mytrial date.

CHECK ONE:

I requestaJURYTrial.

I waive my right to a Jury Trial and request a trial before the court (Trial before a Judge).

SIGNATURE_______________________________________________

DATE_______________________________________

IREQUEST FORM FOR DRIVING SAFETY COURSE (mail to COURT if

requesting

DSC)

(FAILURE TO REMITTHIS FORM ON OR BEFOREYOUR APPEARANCE DATE WILL RESULT IN INELIGIBILITY FORTHE COURSE.)

Please

indicate True or False

to the

statements listed.

If ANY are False, you are NOT eligible for the Driving Safety Course and you must refer to the above form.

I have completely filled out (checked the box requesting D.S.C.) and enclosed the REPLY FORM (Section A, Box 2).

I possess a valid TEXAS driver’s license or permit.

I have NOTtaken a driving safety course in lieu of paying afine during the past year.

lam NOT in the process of taking a driving safety course to dismiss another offense.

This violation did NOT occur in a construction zone while workers were present.

I understand I CANNOTtake the driving safety course in lieu of paying thefine if lam accused of speeding 25MPH or more overthe posted speed limit, or 15

MPH overthe posted speed limit in a commercial motor vehicle when a commercial drivers license was required.

I enclose proof of Financial Responsibility (insurance). (A photocopy is acceptable--NO ORIGINALS PLEASE)

I enclose a money order or cashier’s check (NO PERSONAL CHECKS) made payable to the Columbus Municipal Court in the amount of $109.10 ($134.10 if

violation occurred within school zone.

I understand that

this form Must be NOTARIZED.

I understand that lam responsible for completing a D.P.S. approved Driving Safety Course within 90 days from the date this form is notarized.

I understand that I must remitthe

proper DSC completion certificate to the Court before the expiration of 120 days from the notarized date.

I have completed and mailed the form requesting my driving record to D.PS. in Austin with $10.00.

I do NOT

possess a Commercial Driver’s License. (If you possess a CDL you are not eligible to take DSC.)

IF YOU HAVE COMPLIED WITH THE ABOVE REQUIREMENTS, YOU ARE ELIGIBLE FOR THE DRIVERS SAFETY COURSE AND WILL NOT

RECEIVE ANY FURTHER CORRESPONDENCE FROM THE COURT.

Under Penalty of Perjury, I swear or affirm that

the above is true and correct.

SIGNATURE

SWORN TO AND SUBSCRIBED BEFORE ME this the

day of_________________________ 20

(SEAL)

NOTARY PUBLIC

REQUEST FOR DEFERRED DISPOSITION

apply to the Court for deferred adjudication complete the following:

Plead guilty or no contest on Section A, Check Box 3

I do NOT possess a Commercial Driver’s License. (If you possess a CDLyou are not eligible to take Deferred Disposition regardless of the vehicle operated.)

If you are 25 years or under, by law you are required to take and complete a Driver’s Safety Course.

Provide proof of current liability insurance

Complete a requestfor your driving record and mail to DPS

I enclose a money order or cashier’s check

(NO PERSONAL CHECKS)

made payable to the Columbus Municipal Court in the amount of the fine.

Send this form to the Court prior to your court date.

I hereby request deferred adjudication for charge(s)______________________________________________________

listed in Section A above.

SIGNATURE_______________________________________________

DATE_______________________________________

Mail to: Columbus Municipal Court,