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2. PLEASE CONTACT THE COURT AT 979-415-2757 TO VERIFY CASE STATUS BEFORE PROCESSING YOUR REQUEST.

4. Defendant:*
5. Ticket #: *

7. I waive my right to be represented by an attorney, waive my right to a jury trial, and enter a plea of

8. Plea*

   1. Guilty
   2. No Contest
10. I would like to request a payment agreement for the full amount of the following violations on my citation:
12. Violation:*
13. Violation:
14. Violation:

16. I agree to pay all fines and costs at the designated interval selected below, with my first payment to be made two weeks from the date this request is submitted to the court.

18. Designated Intervals*

    1. $25 every week
    2. $50 every 2 weeks
    3. $100 monthly

20. Payment Method Options:

    1. At Court Window: cash, check, or credit card (Mastercard, Visa, or Discover - no fee charged)
    2. Online Payments (no fee charged): https://lkjk-egov.aspgov.com/Click2GovCS/index.html
       1. NOT AN OPTION UNTIL 30 DAYS HAS PASSED
       2. Click Case/Docket Search - In the search by field you may search by different methods other than your citation number.
       3. Call the Municipal Court to confirm payment has been received.
    3. Automated payment system: Dial 1-888-827-4245.  When you access the automated payment system, you will need to know your citation number and will enter it followed by the #key.  There will be a convenience fee added to the amount you are paying.  
    4. Mail cashier’s check or money order payments: Lake Jackson Municipal Court, 5 Oak Drive – Suite B, Lake Jackson Texas 77566 
    5. A night drop is located at Municipal Court for after-hours payments.  Make check or money order payable to CITY OF LAKE JACKSON (no cash please)

22. I understand an additional fee will be applied to any unpaid balance if the total amount owed is not paid on or before 30 days from the date of final judgment. I also understand that choosing this option will result in a conviction being entered and the violation(s) may be reported to the Texas Department of Public Safety, which may affect my driver license.

24. IF I FAIL TO MAKE PAYMENTS AS SCHEDULED, A WARRANT WILL BE ISSUED ON EACH OPEN CASE FOR MY ARREST FOR THE REMAINING AMOUNT OF THE FINE AND COSTS PLUS WARRANT FEES.

26. I hereby affirm that all of the above is true and correct. By entering my information below I am acknowledging that I am the person named as the defendant in this case.

28. Please forward my payment receipts to the following address and I understand I am required to notify the Court of any change of address,
30. Defendant:*
32. Address1*
33. Address2
35. City*
36. State*
37. Zip*
39. Phone Number:*
40. Email*
42. Today's Date:*
    Today's Date:
44. *WARNING: Making a false entry on this form is a jailable offense and will invalidate your plea.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

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