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2. Read Carefully and Completely

   This form allows you to enter a plea, request a suspended sentence, and take a State-approved Tobacco Awareness Course to disposed of your case. You are required to provide a government issued photo ID with this request. DO NOT use this form if you are a JUVENILE under the age of 17 years old.

   Court staff will review the request and you will be contacted by email or by phone once a determination has been reached about your eligibility. Submission of this form does not guarantee approval. If your request is granted, the court will enter a Judgment of Guilt with Suspended Sentence pending the completion of an approved tobacco class. A copy of the order with information on payment of costs and the tobacco program will be emailed to you.

   REMINDER. Payment of court costs can only be made AFTER the court has entered a judgment.

4. Upload DL, ID, or Passport (required) *
8. First Name*
9. Last Name*
11. Street*
12. Apt./Suite No.
14. City*
15. State*
16. Zip*
18. Phone Number*
19. Email Address*
21. To the case below, I enter a plea of*
    -- Select One --NO CONTEST
23. Citation Number*
24. Issue Date*
25. Violation*
27. I swear or affirm that the following statements are true:*

    1. I am the person charged with this violation(s) and making this request voluntarily
    2. I waive my right to a jury trial and waive the objection to any defect in the charging instrument, the filing of a sworn complaint and notice of a sworn complaint.
    3. I acknowledge that I have the ability to pay the court fees and have contacted the court and understand the amount of fees due.
    4. I understand that failure to comply with my order may result in a Final Judgment of Guilt and a fine amount separate from the fees paid may be imposed.
    5. I understand that failure to comply with the terms of my Judgment and Order by failure to pay the assessed fees or completion of any requirement imposed, will result in a mandatory court appearance
29. Electronic Signature*

    Typing your name here represents your electronic signature

31. DRIVER'S LICENSE OR I.D. UPLOAD*

    You must attach a scanned image of your DL or any govt.-issued picture ID.

Leave This Blank:


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

* indicates a required field