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2. Oath
   I, having been duly sworn upon oath state:
   
   That, I have a valid Texas driver’s license or permit: that my driving record, as maintained by the Texas department of public safety, does not indicate successful completion of a driving safety course within one year immediately preceding the date of the offense alleged in this cause: that I will provide, along with this affidavit, proof of financial responsibility (commonly in the form of insurance) as required by chapter 601, Texas transportation code; and that I am not in the process of taking a driver’s safety course under 543.103, Texas transportation code, nor have I completed such a course that appear on my driving record.
   
   Based on the foregoing, I hereby waive by jury and enter a plea of nolo contendere and request the court to defer proceedings and allow me ninety (90) days to complete a driving safety course approved under the Texas driver and traffic safety education act. I agree to submit proof of completion of the driving safety course and a certified copy of my driving record from the Texas department of public safety within thirty (30) days after completing the course.
   
   I understand that any proof of financial responsibility is subject to verification by the court, that my eligibility for dismissal may be voided if such proof is found to be invalid, if any information is incorrect, or if proof of completion of a driver’s safety course and certified copy of my driving record are not provided with in the applicable time. I further understand that I must submit all applicable costs and fees with this affidavit and that such payments are non-refundable. (court costs of $109 and $134 for school zone violations)
   
   To request permission to take driving safety course by mail, the following must be postmarked by your court date.

   • Signed and notarized affidavit
   • Copy of driver’s license
   • Copy of insurance card (must have your name as a licensed driver)
   • Court costs of $109.00 and $134.00 for school zone violations. (Money order made payable to Angleton Municipal Court, no checks.)

   Permission to take the course will be mailed with a receipt for your court costs.
4. Defendant Signature
5. Date
   Date
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7. 1. Receive an email copy of this form.
8. Email address

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9. Submit

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