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2. First Name
3. Last Name
5. Date of Birth*
   Date of Birth

7. I understand that I may have this violation deferred from conviction and placed on Deferred Disposition (Probation). I also understand that I must meet all eligibility requirements to receive the Court’s permission.

9. By checking each of the statements below, I swear that the following are true and correct to the best of my knowledge:

11. I waive my right to a jury trial or other hearing by the Court and enter a plea of (choose one):*
    -- Select One --No ContestGuilty
13. I am not charged with speeding 35 mph or more over the speed limit.*
15. I am not charged with a moving violation that occurred in a construction zone with workers present.*
17. I am not charged with passing a school bus or leaving the scene of an accident*
19. I do not possess a Commercial Driver’s License and did not possess one at the time of the offense.*
21. I am not currently on Deferred Disposition for any violation in the City of Decatur.*
23. I understand that as a term of my Deferred Disposition, I shall not be convicted of any offense during my probation period (30 days)*
25. I understand that if I was under the age of 25 at the time of the offense, and charged with a Rules of the Road offense, that I must complete a Driving Safety Course as a condition of my deferred and provide Driver’s Safety Course certificate of completion to the court within 30 days. This course must be a TDLR certified, 6 hour, driving safety course.*
27. If charged with Failure to Maintain Financial Responsibility, I will provide the Court with a copy of my insurance that lists me as an insured driver within 30 days. *
29. I understand that failure to fully complete this form, provide a copy of my driver’s license/ identification, and/or failure to provide payment will result in denial of my request for Deferred Disposition.*
31. Lastly, I acknowledge that after receiving approval from the Court, I will receive a copy of my Order Granting Deferred Disposition. I understand that I will be placed on Deferred and failure to comply with its terms will result in a conviction on my driving record.*
35. Address1
37. Address2
39. City
40. State
41. Zip
43. Email
44. Phone Number
46. Today's Date
    Today's Date
47. Signature
49. Acknowledgment

    By signing this form you are being held to the same standards as if you completed the request in person. Failure to appear for the requested hearing could result in a warrant for your arrest.

51. Agreement

    1. I agree

53. Decatur Municipal Court 

54. 201 E. Walnut St. Decatur, TX 76234 court@decaturtx.org

55. 940-393-0220

58. 
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field