CTS-FRM-101 Revision 16
04/27/2021
Official Court Application (OCA Form)
DEFENDANT’S WAIVER OF TRIAL BY JURY AND PLEA OF GUILTY/NO CONTEST
Comes now the Defendant in person and/or by and through his/her attorney of record and states that said Defendant understands the nature of the charge against
him/her and the range of punishment for the offense charged; that he/she hereby waives the arraignment and reading of the complaint, and represents to the Court that
the Defendant desires to make immediate disposition of this case by now entering a plea of GUILTY NO CONTEST. Further, the Defendant waives a trial by
jury, the confrontation of witnesses, and the right to present witnesses in his/her own behalf, and submits the case to the Court on all issues of law and fact. Wherefore,
Defendant prays that the court proceeds immediately on the filing hereof to accept the plea and waivers and to enter a judgment or deferred judgment of guilty in the
manner provided by law.
Citation # :_________________________ $ ________ Citation # :_________________________ $ ________
Citation # :_________________________ $ ________ Citation # :_________________________ $ ________
Citation # :_________________________ $ ________ Citation # :_________________________ $ ________
Citation # :_________________________ $ ________ Payment Group # :_____________________________
Municipal Court Contact Information / Información de Contacto de Tribunal Municipal
Name/Nombre:_________________________________________________________________________________________________________
First/ Primer Middle/ Segundo Last/ Apellido
Home Address/ Dirección de domicilio:______________________________________________________________________________________
Apt #/ # De Apto. City/State/Zip Ciudad/Estado/Código postal
Mailing Address/ Dirección postal:___________________________________________________________________________________________________
Home Phone/ Teléfono del hogar:_________________
Cell #/ # de celular:______________________
Email/Correo Electrónico:
_______________________
Date of Birth/ Fecha de nacimiento: ________________________ Sex/ Sexo M F
Valid Government ID #
Identificación válida del gobierno _________________________ State or Country/Estado o País _________ Expiration/ Vencimiento: _______________________
Spouse’s Name/Nombre de su esposa/o:__________________________________ Phone Number/Número de teléfono:_____________________________
Marital Status/Estado Civil: Single/Soltero Married/Casado Separated/Separado Divorced/Divorciado Widowed/Viudo
ACKNOWLEDGEMENT- STANDARD PAYMENT PLAN
________________________________________________________________________________________________________________________________
1.) Defendant understands the payment plan terms. 2.) Defendant believes that they have the ability to successfully meet the payment
plan terms. 3.) Defendant declines the opportunity for local program staff to review their payment ability information to consider lower monthly
payments or a longer term.
Personal References / Referencia Personales
1)_________________________________ __________________________ 2)_________________________________ __________________________
Name/Nombre Telephone/Telefono Name/Nombre Telephone/Telefono
I swear or affirm that the information is true, correct, and complete to the best of my knowledge.Juro afirmo que esta información es fiel,
correcta y completa según mi conocimiento.
X___________________________________________ _______________ X_____________________________________ _______________
Defendant Signature/Firma Date/Fecha Reviewed by Deputy Clerk/Subsecretario(a) Date/Fecha
NOTICE: A $15.00 Fee will be due for criminal case(s) only if the total is not paid in full within 30 days of assessment. Only applicable for defendants on payment arrangements.
Selected information may be subject to open records requests, in accord with State and Federal Law. Change of address or name information is required by State Law in Chapter 521
of the Transportation Code.
Nota: Una tarifa de $15.00 por caso (s) criminal (s) solo si el total no se paga en su totalidad dentro de los 30 días posteriores a la evaluación. Sólo aplicable a los
demandados en los planes de pago. Información seleccionada puede estar sujeta a las solicitudes de registros abiertos, de acuerdo con el Estado y la ley federal. Cambiar de
dirección o nombre información es requerido por la ley del estado en 521 de capítulo del código de transporte.
Requirements (Office Use):
Application Issued by Date
Personal Info/Plan interview by Date
Amount Paid: Number of payments Monthly Amt $
6A_____ Non 6A ______ (clerk initial)
Supervisor Review by ______ Date _____
Standard Pay Plan
30 Day
0% Down 5% Down 10% Down 15% Down
Judge Set
App Issued: ________ App Completed: _________ Defendant Interview: ________ Wait time:_____ App Completed: _________ Process Time: ______
________ initial
________ Inicial
______________________________
