CASE NO. JT______A
STATE OF TEXAS IN THE JUSTICE COURT
Vs. PRECINCT 3, PLACE 1
______DALLAS COUNTY, TEXAS
DEFENDANT
SPECIALIZED DRIVING SAFETY COURSE - CCP 45.0511(u)
Child Passenger Safety Seat Systems
Before me, the undersigned Justice Court clerk in and for the County of Dallas, State of Texas, on this day personally appeared the undersigned affiant, and who after being by me duly sworn, deposes and says:
(Initial)______I hereby waive my right to a jury trial and legal counsel, and have entered a plea of (circle one) guilty or no contest.
If I decide not to take the specialized driving safety course within the prescribed time, the total fine will be due.
(Initial)______I hold a valid Texas driver’s license and have evidence of financial responsibility (insurance coverage).
(Initial)______I have not completed a driving safety course within 12 months preceding the date of the offense subject to this request that included the specialized instruction on the use of child passenger safety seat systems. I am not currently signed up to take a specialized driving safety course for any other citation which is not yet reflected on my driving record.
(Initial)______I understand that I have 90 calendar days from today’s date to complete an approved specialized driving safety course.
(Initial)______I am responsible for returning to this Court with written proof showing that I have completed the specialized driving safety course and I hereby promise to present such proof by mail or in person no later than 90 calendar days from today’s date.
(Initial)______I understand that I am required to obtain my driving record from the Texas Department of Public Safety and return that driving record to the Court with the certificate of completion of the specialized driving safety course.
(Initial)______I understand that if I fail to comply with the 90 day provision I will be required to appear in Court to SHOW CAUSE why I have failed to furnish proof of successful completion of an approved specialized driving safety course. I further understand that my case will not be dismissed until the Court receives all the following:
1. This Affidavit
2. Original completion certificate from the specialized driving safety course, including four hours of instruction that encourages the use of child passenger safety seat systems. [For COURT: JP 3-1 Cercone] or pay fine $______
3. Certified Driving Record from the Texas Department of Public Safety
4. Copy of Insurance coverage
5. Pay $______for the court fee and court costs, plus $2.00 transaction fee.
(Initial)______I understand that when I have completed the above conditions and have returned proof thereof, the Court will dismiss my traffic citation and the violation will not appear on my driving record, and that it will be noted on my driving record that I have completed a specialized driving safety course.
(Initial)______I understand that the approved driving school will charge a fee for the specialized driving safety course.
(Initial)______I understand that the $______Court Fee/Costs plus a $2.00 transaction fee is due before ____/____/______.
(Initial)______I understand that the Court Fee/Costs plus transaction fee is non-refundable, whether or not I complete the specialized driving safety course.
______Date ______
AFFIANT (signature)
SUBSCRIBED AND SWORN TO BEFORE ME, THIS ______DAY OF ______, ______.
[ s e a l ]
______
JUSTICE COURT CLERK / NOTARY PUBLIC
DEADLINE TO BRING OR MAIL THE FOLLOWING IS ____/____/_____
(1) This Affidavit (2) Course Certificate for COURT: JP 3-1 Cercone or pay fine $
(3) Certified DL Record (4) Copy of Insurance (5) Court Fee