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Court Date Request

2. Defendant Name:*

3. Ticket No.:*

5. I would like to request a court date for Tuesday,

   I would like to request a court date for Tuesday,

6. Court Date
   -- Select One --1/29/20192/5/20192/19/2019

8. I understand that court starts at 5:00 pm. Check-in begins at 4:30 pm.

   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.

   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.

    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.

    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.

    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 (optional)

31. *WARNING: Making a false entry on this form is a jailable offense and will invalidate this request.

    *WARNING: Making a false entry on this form is a jailable offense and will invalidate this request.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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