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IN THE COUNTY COURT OF THE FOURTH JUDICIAL CIRCUIT,
IN AND FOR CLAY COUNTY, FLORIDA
THE STATE OF FLORIDA, CASE NO.:
CITATION NO.:
vs. CHARGE:
,
Defendant.
/
DRIVER IMPROVEMENT AFFIDAVIT
WARNING – Do not sign this affidavit until you are sure you understand all terms of the Traffic
School option. A failure to understand could result in the loss of your Driver’s License. There are
NO EXTENSIONS and NO EXEMPTIONS. If you do not attend traffic school, after this election,
your license will be suspended and points will be assessed. Also, additional penalties and fees
will be incurred before you are able to obtain a valid driver’s license. This will also result in the
forfeiture of one of your five (5) school elections allowed by the State of Florida. You will not be
eligible for traffic school again for twelve (12) months from the date below.
PLEASE CHECK YES OR NO
Have you elected to attend a Driver Improvement Course (not
including this election) within the last twelve (12) months?
YES NO
Have you elected to attend a Driver Improvement Couse more than five
(5) times within a lifetime?
YES NO
Do you hold a Commercial Driver’s License (CDL)?
YES NO
If you answered YES to any of the above questions, YOU ARE NOT ELIGIBLE AT THIS
TIME FOR THE SCHOOL OPTION.
I am electing to attend a Driver Improvement Course approved by the State of Florida, and I
understand that pursuant to section 318.14, Florida Statute, I may attend a school of my choice,
but it must be taken within this state. I shall provide proof of completion to the Clay County Clerk
of the Circuit Court, within 90 days from this day of , 20 . The
deadline date is .****
Defendant Signature
Sworn to and subscribed before me day of , 20
DEPUTY CLERK/NOTARY
