I, hereby enter a plea of ( )GUILTY ( )NOLO CONTENDRE and request that I be placed on Deferred Disposition. I understand that this is 60 day probation period and that there is a required fee of $25.00 that will be added on to the total fine amount.
Citation Number________________ Date______________________
Address_________________________________________________
City_______________________ St.______ Zip________________
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THIS MUST BE TURNED IN BY YOUR ORIGINAL COURT DATE.