Application for Deferred Disposition (Probation)

2. First Name*
3. Last Name*
5. Phone Number*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. E-mail Address*
17. Ticket #*
19. Violation
21. Type of Violation*
    -- Select One --Any violation involving a motor vehicle (excluding insurance violations)InsurancePenal Code / City OrdinanceAlcohol (Minor & Juveniles must appear in court)
23. Do you have a valid driver's license?*
    -- Select One --YesNo
25. Do you or did you hold a commercial driver's license on the date the offense was committed?*
    -- Select One --YesNo
27. Are you younger than 25 years of age? If yes, you may be required to complete a driving safety course (Defensive Driving) during the deferral period.*
    -- Select One --YesNo
29. Are you now on Deferred Disposition (Probation) for a citation of any type?*
    -- Select One --YesNo
31. Have you had a citation for the type checked above dismissed within the past 12 months preceding the date of this ticket?*
    -- Select One --YesNo
33. How do you wish to plea?*
    -- Select One --GuiltyNo contest
35. Defendant Signature*
36. Date*
    Date
39. **It is a state jail felony to make a false statement on this document.**
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