APPLICATION FOR TRAFFIC SAFETY PROGRAMI am applying for the Traffic Safety Program. I understand that if I comply with all of the terms of the Program, my case will be dismissed. I understand that if I fail to comply with anyone of the terms of the Program, the Delaware Municipal Court will accept my guilty plea and I will be convicted of all of the offenses with which I am charged. In either event, I understand that I will not be entitled to any refund of any money paid to the court or to the Defensive Driving Course described below. I understand that only minor misdemeanor moving violations are eligible. I understand that under the terms of the Program, I am responsible for all of the following:1.Mail or otherwise deliver all of the following to the Delaware Municipal Court before my scheduled court appearance:a.Sign and complete this application acknowledging myacceptance of all the terms contained in this application;b.Sign and complete the guilty plea and waiver of trial contained on the reverse side of my ticket --OR--enter a guilty or no contest plea in writing, waiving all of my constitutional rights;c.Provide proof of automobile liability insurance covering my operation of the vehicle at the time that I committed the offenses with which I am charged.d.Enclose a check or money order in the amount of the total sum of all scheduled waivers for all of the offenses with which I am charged.2.Make independent contact with the Safety Council of Central Ohio's Defensive Driving Course at (614)225-6933, sign-up for, pay for, and complete the course. To qualify, the course must be a minimum of six (6) hours.5.Providing the Delaware Municipal Court with proof of successful completion of the Defensive Driving Course within 60 days after my scheduled court date by sending the original completion certificate to the Court. Copies of course completion certificates will not be accepted as proof of completion of the course.I understand that if for any reason I am ineligible for the Program, the court will notify me and schedule a new court date. In such an event, I understand that any money I have paid to the court will be held as bond.By signing below, I certify, under the penalties of R.C. 2921.13, that I have not previously utilized this Program. I understand that I am ineligible for this Program if this is not my first participation in the Program or if my offense is not a waiverable minor misdemeanor moving violation. I expressly accept all of the terms of the Program and waive any claim of error in these proceedings that may be based upon variation from any procedure otherwise provided for under Ohio law.DEFENDANTDATEADDRESSCITY, STATE, ZIP CODEPHONE NUMBERCONTACTINFORMATION:DelawareMunicipalCourt,70N.UnionStreet,Delaware,Ohio,43015. (740)368-1555 email: clerk@municipalcourt.org. For additional information visit www.municipalcourt.org on the Internet.ADM-12 15M/4-982002 © American LegalNet, Inc.
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