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2. Instructions: You have 20 business days after receiving your citation to handle your citation.
4. If your request pertains to more than one offense, a separate form is needed for each offense.
6. Defendant’s Name:*
7. Date of Birth:*
8. Driver's License:
10. Citation Number and Offense:*
11. Citation Number and Offense
13. Citation Number and Offense
14. Citation Number and Offense
16. Address*
18. City*
19. State*
20. Zip*
22. Cell Number:*
23. Email Address*
27. I am requesting a 30 day extension to pay my fine in full. (PERSONAL AND BUSINESS CHECKS ARE NOT ACCEPTED)
29. Please be advised that if your payment is not made in full in 30 days the following with apply:
31. o If any portion of the fines, fees and costs exceeds 30 days from the date of judgment, a $15.00 “Time Payment Reimbursement Fee” will be added as required by law.
33. o DPS notification for ineligibility for renewal on your driver’s license with an additional fee of $10.00 added to the offense (per citation).
35. o A warrant of arrest will be issued with a warrant fee of $50.00.
37. PRIOR TO ENTERING YOUR PLEA OF GUILTY OR NOLO CONTENDERE, YOU HAVE THE OPTION TO VIEW ALL DOCUMENTS AND EVIDENCE IN YOUR CASE, EXCLUDING THOSE DOCUMENTS ORDERED WITHHELD BY A COURT OF PROPER JURISDICTION. BY SUBMITTING THE EXTENSION TO PAY REQUEST YOU WAIVE YOUR OPTION TO REVIEW THE DOCUMENTS AND EVIDENCE IN YOUR CASE.
39. I am entering a plea of: *
    -- Select One --No ContestGuilty
41. for the offense above. I do hereby waive my right to a jury trial and request to pay my fine in full. Your extension notice will be emailed to you so please check not only your regular email folder but also your junk/spam folder for your notice.
43. Defendant Signature (Type name if you agree to the terms of this form.): *
44. Date:*
    Date:
46. It is your responsibility to follow up with the court at 512-327-1862 to verify receipt of your request.
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field