SAFETY COURSE
(FAILURE TO REMIT THIS FORM ON OR BEFORE YOUR APPEARANCE DATE ON YOUR TICKET WILL RESULT IN INELIGIBILITY FOR THE COURSE)
If you meet ALL of the following requirements below, you may be eligible for Driving Safety Course.
_____I hereby plead NO CONTEST.
_____I possess a valid Texas driver's license or permit. CDL (Commercial Driver License) holders do not qualify)
_____I have not taken a driving safety course in the past 12 months.
_____I am not in the process of taking a driving safety course to dismiss another offense.
_____I understand I CANNOT take the driving safety course in lieu of paying the fine if I am accused of speeding 25 miles an hour or more over the posted speed
limit.
_____I ENCLOSE proof of Financial Responsibility (Insurance) & Driver's License. (A photocopy is acceptable)
I ENCLOSE a money order or cashier check made payable to Wortham Municipal Court in the amount of $104.00
_____I ENCLOSE a self-
_____I understand that I am responsible for completing a STATE approved Driving Safety Course and remit the proper completion certificate to the Court before the expiration of the 90 days (Date given by the Court).
_____I understand that this form must be NOTARIZED (if you are mailing the request to the Court)
SWORN TO AND SUBSCRIBED BEFORE ME this the _____ day of _______________, 20 __.
__________________________
NOTARY PUBLIC (SEAL)
IF YOU FAIL TO RESPOND IN WRITING TO THIS TICKET BY THE APPEARANCE DATE SHOWN ON THE TICKET, AN ADDITIONAL CHARGE MAY BE ASSESSED AGAINST YOU FOR FAILURE TO APPEAR, AND WARRANTS MAY BE ISSUED FOR YOUR ARREST.
JUVENILES 16 & UNDER MUST APPEAR WITH PARENT OR Guardian
Shirley Mays
Municipal Court Judge
Pay Municipal Court Fines -
ONLINE GO TO www.certifiedpayments.net
YOU WILL HAVE TO HAVE THE WORTHAM CODE 7051856
YOU CAN ALSO CALL 1-

