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2. Refer to the Deferred Disposition Order for conditions required during the probationary period. Attach applicable documentation below.
4. Date*
   Date
6. First Name*
7. Last Name*
9. Email Address*
10. Phone Number / Text Number

    In providing your phone/text number, you are agreeing to receive notifications and/or scheduling information about the case.

12. Ticket Number*
13. Violation/Offense*
15. Document Upload

    Any/all documents requiring a signature MUST be signed.

17. Driving Safety Course Certificate
18. DPS Road Test
20. Alcohol Awareness Course
21. Community Service Hours
23. Tobacco Awareness Course
24. Insurance (Date of Deferral Period)
26. Other
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field