DRIVING SAFETY COURSE FORM:
I, hereby enter a plea of ( )GUILTY ( )NOLO CONTENDRE and request that I be allowed to take a Driving Safety Course. I understand that I can only have one offense dismissed with this course. The required fee of $110.00 (or $135.00 if in school zone) in the form of a money order or cashier's check is enclosed. I have also enclosed a copy of my insurance and a copy of my ticket.
STATE OF TEXAS
COUNTY OF ______________
I,_________________________, do hereby certify that I am not in the process of taking a Driving Safety Course, and I have not taken a Driving Safety Course that is not yet reflected on my driving record in the past 12 months.
_____________________________
Signature
SWORN TO AND SUBSCRIBED BEFORE ME, this_______ day of ________A.D, 20_____.
_____________________________
Notary Public
State of Texas
THIS MUST BE TURNED IN OR POST-DATED BY YOUR ORIGINAL COURT DATE.