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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 you documents.

   False statements or documents to the Court will be considered perjury and referred to the Tarrant County District Attorney's office for prosecution.

5. Citation Number: *
6. Violation:*
8. First Name*
9. Last Name*
10. Date of Birth:*

    MM-DD-YYYY

12. Cell/Primary Phone*
13. Email*
15. Drivers Safety Course Certificate *

    Upload a SIGNED copy of your DSC Certificate 

17. Driving Record 3A*

    Upload a copy of your driving record 3A

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field