Deferred Disposition Request Form

2. Full Name

   I have been charged with the following offense, in the Municipal Court of the City of Post.

3. Offense

5. Plea

   I do hereby enter my appearance to the offense charged and plea:

   1. No Contest- I understand that my plea of No Contest will have the same force and effect as a plea of guilty on the judgment of the court.
   2. Guilty
7. Request & Understanding
   I request that the Court grant me the deferred disposition ( informal probation)option, since I: <ul><li>Do not hold a commercial drivers license (CDL)</li> <li>Was not speeding 25 miles per hour or more over the posted speed limit</li> <li>Was not charged with a violation occurring in a construction zone while workers were present</li> <li>Was not speeding 95 miles or more</li> <li>Was not charged with passing a school bus</li> <li>Was not charged with failing to stop and provide information or render aid after an accident</li> <li>Was not charged with committing a serious traffic violation</li> <li>I understand that in order to have a violation dismissed, I must comply with specific terms of probation that will be provided to me in the form of a court order, mailed to the address at the bottom.</li></ul><br>Terms of probation may include any of the following items: <ul><li>Payment of all fines, fees and court costs</li> <li>Maintaining a clean driving record for the entire term of probation</li> <li>Completion of a driving safety course (If under 25 years of age)</li> <li>Re-taking the DPS driving test (If under 18 years of age)</li> <li>Maintaining valid liability insurance for the entire term of probation (Insurance violations only)</li> <li>Any other term(s) required by the court</li></ul>

   I request that the Court grant me the deferred disposition ( informal probation)option, since I:

   • Do not hold a commercial drivers license (CDL)
   • Was not speeding 25 miles per hour or more over the posted speed limit
   • Was not charged with a violation occurring in a construction zone while workers were present
   • Was not speeding 95 miles or more
   • Was not charged with passing a school bus
   • Was not charged with failing to stop and provide information or render aid after an accident
   • Was not charged with committing a serious traffic violation
   • I understand that in order to have a violation dismissed, I must comply with specific terms of probation that will be provided to me in the form of a court order, mailed to the address at the bottom.

   
   Terms of probation may include any of the following items:

   • Payment of all fines, fees and court costs
   • Maintaining a clean driving record for the entire term of probation
   • Completion of a driving safety course (If under 25 years of age)
   • Re-taking the DPS driving test (If under 18 years of age)
   • Maintaining valid liability insurance for the entire term of probation (Insurance violations only)
   • Any other term(s) required by the court

9. Enclosed Items

   I am enclosing the following required items:

   • Deferred Disposition Request form
   • A copy of my driver’s license (Not a CDL)
   • Payment of fine, court costs and fee (Call the court for the correct deferral amount)
   • Current proof liability insurance (Insurance violations only)

11. First Name

12. Last Name

14. Address1

16. Address2

18. City

19. State

20. Zip

22. Citation Number

23. Date of Birth
    Date of Birth

25. I want to update my address with the court.

    1. Yes
    2. N/A

27. Driver's License Number

28. Issuing State

30. Signature

31. Today's Date
    Today's Date

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field