Fillable Traffic Diversion Application (County of Fulton)

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Traffic Diversion Application (County of Fulton)

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U.S.A. forms for County of Fulton

BROWSE COUNTY OF FULTON (NY) FORMS

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CHAD W. BROWN
DISTRICT ATTORNEY
COUNTY OF FULTON
State of New York
Fulton County Office Building
Johnstown, NY 12095
Phone: (518) 736
-
5511
Fax: (518) 762
-
2042
APPLICATION FOR VEHICLE & TRAFFIC DIVERSION PROGRAM
Please fill out form then print, initial and sign in the designated places
Driver’s License Number: _____________________ Driver’s License State: ______
First name: _________________ Middle Initial: ___ Last name: __________________
Current Street Address: __________________________________________________
City: _____________________ State: _____ Zip Code: __________
Date of Birth: ____________
Email Address: __________________________
Telephone #: ___________________________
Insurance Co. Name: ______________________________ Policy #: ______________
Exp. Date: ________
Charges: ______________________________________________________________
(Please attach copy all tickets)
VTL Section(s): _________________________________________________________
Court: ___________________
To be eligible to enter the traffic diversion program I must meet the following requirements:
1. I have not previously completed the Fulton County Vehicle & Traffic Diversion
Program within the 18 months before this application.
2. I have not had any Vehicle and Traffic Law Convictions (i.e. point violations)
within the last 18 months in any court.
3. If currently charged with a speeding offense, it was for driving 20 miles per hour
or less over the posted speed limit.
4. There was no motor vehicle accident involving someone other than me.
5. I did not receive more than 6 points on the tickets I received at the time I was
stopped.
6. I have answered and pled not guilty to the ticket prior to the return date listed on
the ticket.
7. I have not missed any scheduled court appearances without prior approval from
the court. If accepted into the diversion program, I will continue to make any
scheduled court dates.
8. I have not had my license suspended for failing to answer the ticket I am seeking
to have dismissed through the diversion program.
9. I have not been convicted of or plead guilty to the ticket for which I am seeking
dismissal via the diversion program.
10. I have not been previously convicted of any Felony, any alcohol or drug related
driving offense within the last 10 years, Reckless Driving (VTL 1212), Leaving
the Scene (VTL 600-1a) in New York or any other state.
11. All the tickets in this case are Vehicle and Traffic Law and/or Transportation Law
charges (e.g. not Penal Law, Environmental Conservation Law, Tax, etc.)
______________________________________________________________________________
By initialing __________, I agree that if I misrepresent any of the above facts or affirmations, I forfeit
the $200.00 application fee and I will be terminated from the diversion program and the tickets will
still be pending.
By initialing __________, I hereby apply to the Fulton County Vehicle & Traffic Diversion Program.
In doing so, I request a 60-day adjournment to attend a Defensive Driving Course and complete the
diversion program. I understand that my acceptance into the program is based on my meeting the
conditions above. I am waiving all Speedy Trial Rights.
By initialing __________, I agree that failure to respond to any information or giving false or
incorrect information in the application is grounds to deny entry into the program, forfeiture of the
$200.00 application fee, and removal from the program.
By initialing __________, I agree that failure to complete the program within 60 days may result in
termination from the program and forfeiture of the $200.00 application fee which will result in me
having to appear in court to answer the ticket as if though I never applied for the program.
By initialing __________, I agree that if I chose to complete an on-line Defensive Driving Course or
an in-person DDC, I am responsible for any and all fees that may be required above and beyond the
application fee for this program and I am responsible for sending in a certificate of completion to the
District Attorney’s Office. Please be aware that your certificate may not be mailed until 14 to 21
business days after you complete the course.
By initialing __________, I agree to waive any right under VTL section 1806 to have a conference
with the prosecutor.
WARNING: If you have not received formal notice from the District Attorney’s Office that your
Traffic Diversion application has been approved, you must appear at the date and time indicated on
your Simplified Traffic Information (i.e. your ticket) or as directed by the court. Failure to do so may
result in a suspension of your license and/or a bench warrant being issued for your arrest.
Please include ALL of the following with your application:
A non-refundable, certified bank check (not a personal check) or money order for
$200.00 made payable to the Fulton County Traffic Diversion Program.
AND THE FOLLOWING:
A copy of all Traffic Tickets (or Court notice in absence of ticket(s));
A copy of your Driving Abstract (can be obtained at any DMV or online);
Proof of valid motor vehicle insurance and;
Self addressed, stamped envelope.
*** Each item listed MUST accompany your application***
Please mail your application to:
Fulton County District Attorney’s Office
C/O Traffic Diversion Program
223 West Main Street
Johnstown, NY 12095
Once accepted into the Fulton County Traffic Diversion Program the application fee is non-
refundable. Please make sure all selections are accurate and monies are correct before submitting the
application.
NO PERSONAL CHECKS OR CREDIT CARDS WILL BE ACCEPTED
It is a crime, punishable as a Class A Misdemeanor under the Laws of New York, for a person, in
and by written instrument, to knowingly make a false statement, or to make a statement, which
such person does not believe to be true.
AFFIRMED UNDER PENALITY OF PERJURY.
Completed and signed on ____________ _____________________ ________________
(date) (Signature of Applicant) (Print Name)
***DO NOT CALL THE DISTRICT ATTORNEY’S OFFICE IN REGARDS TO THE
STATUS OF YOUR APPLICATION. FOR AN UPDATE YOU MAY EMAIL THE
TRAFFIC DIVERSION PROGRAM AT Trafficdiversion@fultoncountyny.gov.
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Traffic Diversion Application (County of Fulton)

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Completed 6 August 2020

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