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Driver Safety Course Affidavit

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CAUSE NUMBER

STATE OF TEXAS
VS
DEFENDANTS NAME

IN THE MUNICIPAL COURT
CITY OF WATAUGA
TARRANT COUNTY, TEXAS

Last Name*

First Name*

Address line 1*

Address line 2

City*

State *

Zip Code*

Phone Number *

REQUEST FOR A DRIVING SAFETY COURSE

I hereby enter my appearance under Art. 45.0511(b)(1) of the Code of Criminal
Procedure on the complaint of the offense of

Name of violation: *

I understand that I have a right to a jury trial. I hereby waive my right to a
jury trial, plead (guilty)(nolo contendere) and request to take a driver safety
course.

guilty

nolo contendre

I understand that I must, within 90 days of this request:

1. Present to the court a valid Texas Driver's license;

2. Present to the court proof of financial responsibility (vehicle liability
insurance);

3. Present to the court a certified copy of my driving record from the Department of Public Safety;

4. Take a driver safety course approved by the Texas Education Agency or, if operating a motorcycle, a motorcycle operator's training approved by the DPS;

5. Present to the court a uniform certificate of driver safety course completion from a Texas Education Agency approved course (or from a DPS
approved motorcycle course);

6. Pay court costs and a non-refundable administrative fee of $10.00 fee to the court.

I understand that:

1. If I complete a driving safety course within 90 days, the charge against me will be dismissed and the court will report to DPS the completion date of the driver safety course for inclusion on my driving record;

2. If I fail to present to this court proof of completion of the driver safety course within 90 days, the court will require my appearance at a
show cause hearing;

3. If I fail to appear at the show cause hearing, the court will impose the fine and may issue a capias pro-fine warrant for my arrest.

4. I do not hold a comercial drivers license.

Defendant's Signature

Date

Completion Date

AFFIDAVIT

, state under oath that on the date I requested
to take the driver safety course, I was not in the process of taking a driver
safety course under Art. 45.0511 of the Code of Criminal Procedure, nor had I
completed a course under that section that was not yet reflected on my driving
record as maintained by the Texas DPS.

Defendnat's Signature

Sworn and Subscribed before me, on this the ____ day of ____________, 20_____.

____________________________________________
Notary Public In and For The State of Texas

Notary Seal

* indicates required fields.