Standard Reply Form (Page 2 of 2) in pdf

FORM 2: USE THIS FORM FOR REQUESTING DRIVER’S SAFETY COURSE OR ALIVE AT 25 CLASS

READ THIS ENTIRE FORM BEFORE CALLING THE COURT!!!

ALL DRIVERS UNDER THE AGE OF 25 ARE DIRECTED TO TAKE AN ALIVE AT 25 CLASS

(FAILURE TO REMIT THIS FORM & PAYMENT ON OR BEFORE YOUR APPEARANCE DATE WILL RESULT IN INELIGIBILITY)

__________________________________________________________________________________________________

Name (Print or Type as it appears on your driver’s license)

Email Address

Driver’s License Number

__________________________________________________________________________________________________

Current Mailing Address

Telephone Number

__________________________________________________________________________________________________

Date of Birth

Citation Number

Date of Citation

Appear Date

ADMONISHMENT OF RIGHTS

You, the Defendant, have the right to plea guilty, not guilty, or nolo contendere (no contest). You have the right to remain silent. You have a right to

retain an attorney to represent you. You have the right to a jury trial. You have the right to confront and cross-examine the witnesses against you. If

you have insufficient resources or income to pay a fine or costs, you may appear in Court and request the Court to allow you to discharge all or part

of my fine or costs by alternative means such as performing community service. If you are not a citizen of the United State of America, a plea of

guilty or no contest for the offense charged may result in deportation, the exclusion from admission to this country, or the denial of naturalization

under federal law. You have a right to the possession, or notice, of certain evidence upon you request and the right for a record of said possession or

notice to be filed with the Court. Until the Judgment of the Court is satisfied in full, that you are obligated to notify the Court of any change in

my address, telephone number, or other contact information.

PLEA

______ I hereby: ACKNOWLEDGE that I have read the admonishment of rights, WAIVE my rights, and enter a plea of NOLO CONTENDERE (No Contest).

Money Order or Cashier’s Check in the amount of the fine(s) is enclosed. (Make remittance payable to Riesel Municipal Court - PO Box 249 – Riesel, TX 76682)

Please indicate TRUE or FALSE next to the statements listed. If any are FALSE, you are NOT eligible for the Driving Safety Course and you must refer to

Form 1.

______ I hereby plead NOLO CONTENDERE (No Contest) to the charge as required by the traffic law.

______ I have NOT taken a driving safety course during the past 12 months.

______ I am not in the process of taking a driving safety course to dismiss another offense.

______ I have not completed a driving safety course that is not yet reflected on my driving record.

______ I understand that I CANNOT take the driving safety course if I possess a commercial driver’s license or committed a serious traffic offense.

______ I understand that I CANNOT take the driving safety course if the citation was issued in a Work Zone with Workers Present.

______ I understand that I CANNOT take the driving safety course if I am accused of speeding 25 mph or more over the posted speed limit.

______ I ENCLOSE a valid photo COPY of my TEXAS Driver’s License or permit or proof of ACTIVE duty military service if I possess a non-Texas driver’s license

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

______ Instead of paying the traffic fine, I ENCLOSE a money order or cashier’s check in the amount of $109.00 (or $134 if in school zone ) to pay for the court costs

for Driver’s Safety Course (make payable to Riesel Municipal Court)

______ I ENCLOSE a self-addressed, stamped BUSINESS size envelope, in which the Court will mail me an application for a certified copy of my driving record,

which I will send to Austin with the proper state fee as required by law. I understand that FAILURE to request this form will invalidate my request for a

driver’s safety course.

______ I understand that I am responsible for completing a Texas DPS approved Driving Safety Course before the expiration of the 90 day extension, and remitting the

SIGNED “COURT COPY” of the Certificate of Completion to the Court.

______ I understand that this form MUST be NOTARIZED. (Check with your local Bank or school Administration Office.)

______ If mailed, I understand that this form MUST be sent CERTIFIED MAIL. (Check with your local Post Office.)

YOUR SIGNATURE MUST BE NOTARIZED

Subscribed and Sworn before me on _________________________________________.

____________________________________

____________________________________________

Signature of Defendant Requesting DSC

NOTARY PUBLIC

AFTER RECEIPT AND APPROVAL OF YOUR DSC REQUEST BY THE COURT, YOU WILL RECEIVE A FORM WITH THE REQUIRED

COMPLETION DATE AND A FORM TO HAVE A COPY OF YOUR DRIVING RECORD SENT TO THE COURT. YOU MUST COMPLETE THE

DRIVER’S SAFETY COURSE ON OR BEFORE THE 90TH DAY FROM YOUR APPROVAL DATE.

IF YOU COMPLETE THESE REQUIREMENTS, the Court will dismiss your case and report to DPS the date that you completed your course. IF YOU FAIL TO

COMPLETE THESE REQUIREMENTS, you will be required to appear before the Court to show cause why you did not complete them. At the show cause hearing,

the Judge may enter a final adjudication against you and require me to pay the fine. Failure to appear at the show cause hearing will result in a final adjudication being

entered against you and that you will be required to pay the fine and any additional costs required by law.

CHECKLIST: Make sure you have included the following items:

________ 1. Complete and NOTARIZED request form for DRIVER’S Safety Course.

________ 2. CURRENT copy of your Financial Responsibility (insurance).

________ 3. Copy of your Driver’s License or Permit.

________ 4. Self-Addressed, business, stamped envelope.

________ 5. CASHIER’S CHECK or MONEY ORDER ONLY in the amount of $109.00. NO CREDIT CARD OR DEBIT CARD PAYMENTS FOR DRIVERS

SAFETY COURSE! (If in school zone SEND $134.00). Please note: Do not send the original fine amount along with your driver’s safety course payment of $109.00.

ONLY send $109.00.

Standard Reply Form Page 2

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