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2. REQUEST FOR DEFERRED DISPOSITION
4. DATE:*
   DATE:

   DATE:
6. NAME:*
8. STREET ADDRESS:*
10. CITY, STATE AND ZIP CODE*
12. PHONE #:*
14. EMAIL:*
16. CITATION #:*
18. OFFENSE:*
20. I am entering a plea of:*

    1. Guilty

    1. No Contest
22. I am requesting to be granted a deferred disposition and I meet ALL of the following requirements:*

    1. I am 17 years of age or older.
    2. I have a valid, non-commercial driver's license.
    3. I have not been granted a deferred disposition with Webster or any other court in the last 12 months.
24. You must click on one of the following statements:*

    1. I was over 25 years of age when I received my citation.
    2. I was under 25 years old when I received my citation, but it was NOT for a moving violation.
    3. I was under 25 years of age when I received my citation and it WAS for a moving violation. I understand that I will be required to take a driver's safety course as part of my probation.
26. I understand that this form is just a request to be granted a deferred disposition and that nothing has been granted by the judge at this time. I understand I must submit this request with a copy of my driver’s license before my court date.
28. MUST SUBMIT COPY OF DRIVER'S LICENSE:*
30. MUST SUBMIT COPY OF CURRENT INSURANCE IF APPLYING FOR DEFERRED DISPOSITION FOR A NO INSURANCE VIOLATION
32. ELECTRONIC SIGNATURE:*
    Please type full name and date in lieu of signature
34. I WISH TO RECEIVE MY PAPERWORK IN THE FOLLOWING MANNER:*

    1. By mail to the home address provided above

    1. By email to the email address provided above
36. Please contact the court office at 281-338-6702 if you have any questions.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field