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2. Defendant Name:*
3. Ticket No.:*
5. I would like to request a court date for Tuesday,
6. Court Date
   -- Select One --12/19/202301/02/2024
8. I understand that court starts at 5:00 pm. Check-in begins at 4:30 pm.
9. I promise to appear at Lake Jackson Municipal Court of Record at the time and on the date selected above. I understand that failure to appear will result in a warrant being issued for my arrest and/or the inability to renew my driver's license.
10. I understand that if I wish to choose an option in which I do not need to make an appearance before the judge, I can take care of this matter during normal office hours, which are Monday - Friday, 8 am - 5 pm.
11. I UNDERSTAND THAT ANY AND ALL COURT COSTS AND FEE IN REGARDS TO A DRIVING SAFETY COURSE (DSC) AND/OR DEFERRED DISPOSITION (PROBATION) ARE DUE TO BE PAID IN FULL ON THE DATE SELECTED ABOVE. THERE WILL BE NO EXCEPTIONS.
15. I hereby affirm that all of the above is true and correct. By entering my name below, I am acknowledging that I am the person named as the defendant in this case.
17. Defendant *
    Typing your name here constitutes your signature
18. Date*
    Date
20. Address1*
22. Address2
24. City*
25. State*
26. Zip*
28. Phone Number*
29. Email*
31. *WARNING: Making a false entry on this form is a jailable offense and will invalidate this request.
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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