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2. REQUEST FOR EXTENDED PAYMENT PLAN
4. NAME:*
6. STREET ADDRESS:*
8. CITY, STATE AND ZIP:*
10. PHONE #:*
12. EMAIL:*
14. CITATION #:*
16. OFFENSE(S):*
18. PLEA(S):*

    By entering a plea and requesting a payment plan, your charge(s) will be reported to the Texas Department of Public Safety and may appear on your driving record.

    1. Guilty
    2. No Contest
20. Please choose ONE option for your payment plan:*

    1. I am requesting 30 DAYS to pay my fines. I understand that if my balance is unpaid at the end of 30 DAYS, I will be responsible for contacting the court and for paying any extra fees from the State.
    2. I am requesting an EXTENDED payment plan to pay my fines. I understand that $15.00 will be added to each offense and I will then be responsible for making $60.00 biweekly payments.
22. I understand that this form is just a request for an extended payment plan and that nothing has been granted by the judge at this time. I understand I must submit this application with a copy of my driver’s license or ID.
24. SUBMIT DRIVER'S LICENSE OR ID:*
26. ELECTRONIC SIGNATURE:*
    Please type full name and date in lieu of signature
28. I WISH TO RECEIVE MY PAPERWORK IN THE FOLLOWING MANNER:*

    1. By mail to the home address provided above

    1. By email to the email address provided above
30. Please contact the court office at 281-338-6702 if you have any questions.
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

* indicates a required field