REQUEST FOR A DRIVING SAFETY COURSE

 TICKET NUMBER: _________________

STATE OF TEXAS

IN THE MUNICIPAL COURT

VS.

CITY OF SEGUIN

______________________________

GUADALUPE COUNTY, TEXAS

I hereby enter my appearance on the complaint of the offense of: ________________________________________.

I understand that I have a right to a jury trial. I hereby waive my right to a jury trial, plead (guilty)(nolo contendre) and elect to take a driving safety course.

I understand that I must:

_____ 1. Present to the court a valid Texas Driver’s license or permit;
_____ 2. Present to the court proof of financial responsibility (automobile liability insurance);
_____ 3. Present to the court a certified copy of my driver’s record from the Department of Public Safety;
_____ 4. Present to the court a uniform certificate of driving safety course completion form a Texas Education Agency approved course 90 days from this request; and
_____ 5. Pay court costs and an administrative fee to the court. (Total: $ 107.00)

I understand that:

_____ 1. If I complete a driving safety course within the required time, the charge against me will be dismissed and the court will report to the Department of Public Safety the completion date of the driving safety course for inclusion on my driving record.
_____ 2. If I fail to present to this court proof of completion of the driving safety course within the time required, the court will require my appearance at a show cause hearing.

______________________________

________________

________________________

Defendant's Signature

Date

Completion Date

AFFIDAVIT

I, __________________________________, state under oath that I am not in the process of taking a driving a driving safety course, nor have I completed a course that is not yet reflected on my driver’s record maintained by the Texas Department of Public Safety, nor have I taken a driving safety course to have a ticket dismissed in the past twelve (12) months.

______________________________________
 

Defendant's Signature

 Sworn and Subscribed before me, the undersigned authority on this the _____ day of __________________, 2008.

______________________________________
 

NOTARY PUBLIC
 

IN AND FOR THE STATE OF TEXAS