CIVIL TRAFFIC COURT DEFENDANT'S REQUEST FORM & COURT ORDER (A separate request form must be filled out for each case. Please fill out top of form completely) CLOCK IN DATE Date: __________________ Select One: [ ] First Request [ ] Second or More Request I, _______________________________________________ Case #: ___________________________________ Print Name Court Date: _________________________________ Charges: ___________________________________________ REQUEST THE FOLLOWING: [ ] Re-set Pre Trial Conference & Vacate DL Suspension [ ] Reset Trial & Vacate Driver License Suspension [ ] Accept Driving School Completion & Remove Points [ ] Reorder Driving School for Failure to Complete Timely [ ] Vacate my Previous Plea [ ] Vacate Sentence [ ] Mitigate Sentence [ ] Re-Hearing/Reconsideration [ ] Plead Not Guilty ­ Set case for Pre Trial Conference/Trial and request to lift suspension after payment of late fees [ ] Other: ____________________________________________________________________________________ Reason for Request: __________________________________________________________________________ ____________________________________________________________________________________________ Defendant's Address: _________________________________________________________________________ Street City State Zip Defendant's Home Telephone #: _____________________ Work Telephone #: ________________________ I hereby swear or affirm that the above information is true and correct. I understand that filling out and submitting this request form does not stay or in any way affect the status of this case, and does not necessarily mean that this request will be granted by the Judge. I understand that only the Judge in this case can grant this request. ____________________________________________________ Defendant's Signature __________________________________ Date CLOCK IN DATE ORDER It is hereby ordered that the defendant's request is: [ ] DENIED [ ] GRANTED [ ] Upon payment of citation lift suspension [ ] Review of ruling request must be done by Appeal process [ ] Re-set pre-trial conference & lift D6' after payment of late fees waive speedy [ ] Re-set trial & lift D6' after payment of late fees waive speedy [ ] Accept DDS completion in lieu of points [ ] Complete DDS within ________ days (30 days if left blank) in lieu of points [ ] Enter plea of not guilty ­ Set pre-trial conference/trial [ ] Upon payment of late fees lift suspension. [ ] Vacate sentence re-set for trial waive speedy [ ] Set on Admin Docket for ___________ days (30 days if left blank) [ ] Clear D6' prior to, no late fees [ ] No further continuances, Defendant or Legal Rep must appear next date and further; __________________ __________________________________________________________________________________________ Revised: 02/04/2013 American LegalNet, Inc. www.FormsWorkFlow.com