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2. Read Carefully and Completely

   You may use this form to enter a plea, allow the court to enter a final judgment of guilt and request for time to pay. Your plea of Guilty or No Contest will result in a CONVICTION for the offense charged. You will have 30 days after the judgment is signed to pay the fine and costs in full. On day 31, a $15.00 fee will be added to each case that has a balance. Any additional time to pay must be requested in person or by mail. If you are indigent or experiencing financial hardships, you must bring this to the attention of the court and you may be eligible for alternative means to satisfy the judgment.

   A court staff will let you know by email or phone if your request is approved or denied by the judge. REMINDER! THIS IS NOT A REQUEST FOR DISMISSAL.

   WARNING FOR CASES IN ACTIVE WARRANT/S STATUS. Warrants will remain active and you may still be subject to arrest until the court accepts the plea and enter a judgment or order.

4. Certain Convictions

   By voluntarily entering a plea of guilty or no contest using this form, you acknowledge the following: 1.) A conviction for moving violations will be reported to the State and may appear on your driving record. 2.) A conviction for a penal offense may be reported to the State and may have collateral consequences beyond a fine payment.

8. Request for Time to Pay, Plea and Conviction
10. First Name*
11. Last Name*
13. Street*
15. Apt. or Suite No.
17. City*
18. State*
19. Zip*
21. Phone Number*
22. Email Address*
24. To the violations listed below, I enter a plea of*
    -- Select One --NO CONTESTGUILTY
26. Citation Number*
27. Issued Date*
    Issued Date
28. Violation*
30. Citation Number
31. Issued Date
    Issued Date
32. Violation
34. Citation Number
35. Issued Date
    Issued Date
36. Violation
38. Citation Number
39. Issued Date
    Issued Date
40. Violation
42. I swear or affirm that I am the named Defendant making the request, and the following statements are true:
    • I am the person charged with this violation(s) and making this request voluntarily.
    • I waive my right to a jury trial and waive any objection to the filing of a sworn complaint, notice, and any defect in the sworn complaint.
    • I acknowledge and waive discovery per Art. 39.14, C.C.P.
    • I was not charged with an offense involving Domestic Violence.
    • I understand and acknowledge that a conviction for the violation(s) I have plead to may be reported to the State of Texas.
    • I agree to update the court of any change of address, email, or contact number.
    • I am representing to the court that I have the ability to pay the judgment(s).
    • I agree to satisfy the judgments(s).
    • I have read and acknowledge all the information provided in this form.
44. Electronic Signature*
46. DRIVER'S LICENSE OR I.D. UPLOAD*

    You must attach a scanned image of your DL or any gov't.-issued picture ID.

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 Submit and Print

* indicates a required field