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2. 
3. Instructions:

   You must complete this request and submit all documentation required.  It is your responsibility to follow up with the court at 817-985-2140 to verify receipt of your request. After your request is reviewed, the court will e-mail you a notice of your agreements if you meet the eligibility terms. If you DO NOT meet the eligibility terms, court staff will contact you. Please call prior to submitting your request to verify if you are eligible. By submitting the request, you are declaring to the Court that the information provided is correct. False statements to the Court will be considered perjury and referred to the Tarrant County District Attorney's office for prosecution.

   Please note: Not all violations are approved for Deferred Disposition.

5. Deferred Disposition Application
7. Citation Number: *
8. Violation:*
10. First Name*
11. Last Name*
13. Date of Birth:*

    MM-DD-YYYY

15. Address*
17. City*
18. State*
19. Zip*
21. Cell/Primary Phone*
22. Alternate Phone
24. Email*
26. Requirements*

    I, the Defendant in the above-entitled cause, do hereby enter my plea of No Contest or Guilty, waive my right to a jury trial and request Deferred Disposition. I understand that I can only make this written request on or before my appearance date and I must meet all eligibility requirements in order for this request to be granted. I understand that Deferred Disposition is not a right and is offered at the sole discretion of the Court.

    I swear that the following statements are true: 

    • I am not under the age of 17.
    • I waive discovery pursuant to Article 39.14, C.C.P., waive my right to a trial by jury, and enter a plea of NO CONTEST or GUILTY.
    • I was not charged with exceeding the posted speed limit in excess of 24 miles per hour.
    • I am providing the Court with a photocopy of my valid Texas driver's license/permit, which is not revoked/suspended, and is NOT a Commercial Driver's License; and
    • I have not been on Deferred Disposition for another offense within the one (1) year period prior to the offense date in this matter.
    • I understand that I am not eligible if I currently hold a Commercial Driver's License (CDL) or I held a Commercial Driver's License (CDL) at the time of this offense.
    • I am not charged with a Penal code offense.
    • I am not charged with any offense involving alcohol or family violence.
    • I am not charged with any traffic offense committed in a construction zone.
    • I was not involved in an accident. 
    • I will provide FULL PAYMENT of my fees by the due date provided by the Court.
    • If the Court grants this request, I understand that I will be placed on probation for a period of time not to exceed six (6) months.
    • If the Court grants this request, I understand that the Court will require that I not be issued a citation for ANY offense during my probationary period.
    • If the Court grants this request, I understand that the Court may impose additional requirements as it deems appropriate during my deferral period (i.e. attend classes, perform community service, submit to counseling, provide documentation, etc.) and, if ordered to do so, I understand that documented proof of the requirement(s) being met must be filed with the Court in accordance with the terms and conditions set forth on the Order of the Court.
    • If the Court grants this request and I fail to comply with all the terms and conditions set by this Court and/or fail to appear at a Show Cause Hearing for my failure to comply with the requirements of this Court, I understand that a judgment and CONVICTION will be entered against me in this matter and the offense will be reported as required by law. A Capias Pro Fine warrant may be issued for my arrest and I may also be denied renewal of my driver's license until I have paid or disposed of my case.

    1. I swear and affirm I have read and understood the statement above.
28. Plea-Select ONLY one *

    By entering a plea I, the Defendant, do hereby waive discovery pursuant to Article 39.14, C.C.P., waive my right to trial and enter my plea of (please check a box below):

    1. GUILTY
    2. NO CONTEST
30. Age*

    * If the Court grants this request and I was under the age of 25 at the time of the offense. I understand that I am required by law to complete a state approved Driving Safety Course within 90 days and, if I currently hold a provisional driver's license at the time of the offense, I understand I am required by law to take a driving test administered by the Texas Department of Public Safety. 

    1. 25 years of age (at time of citation) and older
    2. 24 years of age (at time of citation) and under
32. Provisional Driver’s License

    Check only if applicable:  Pursuant to Art. 45.051(b-1)(3), C.C.P., the Defendant, who holds a provisional driver’s license, is ordered to submit to a driver’s license examination as required by Section 521.161(b)(2), Transportation Code, regardless of whether the defendant was previously examined, and pay a $10 reimbursement fee to the Department of Public Safety. To be completed no later than 90 days from today.

    1. Yes, it is applicable.
34. Payment Options*
    -- Select One --Pay In full -upon approval Pay In full with in 60 days of request
38. Proof of Driver's License*

    Upload proof of valid  Driver's License.

39. Other documentation (if applicable)

    Upload other documentation (if applicable)

41. * The court may require further information to verify your identity. 

42. 
44. SIGNATURE*

    By signing this form in the space provided above, I hereby swear and affirm that the information provided above is correct.

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field