Form R072413 – Fill Out and Use This PDF

Office of Paula S. O’Neil

Clerk & Comptroller

Pasco County, Florida

ELECTION TO ATTEND A DRIVER IMPROVEMENT COURSE

Ticket Number:

I understand this option is available to me if:

I do not possess a CDL Driver’s License or CDL Learner’s Permit; or

I have not made an election within the last twelve months; or

I have not made five elections in a lifetime; or

I am making this election within 30 calendar days of the date this ticket was issued; or

I have not been charged with a driver’s license, registration, insurance, non-moving violation, or mandatory court violation.

I understand to satisfactorily complete this election, I must:

Mail or bring this election form along with payment for the full amount of the civil penalty to the Clerk & Comptroller’s Traffic Department within 30 days from the date the ticket was issued; AND

Attend and complete a State approved defensive driving course in the State of Florida (refer to the local phone directory yellow pages under Driving Instruction or Traffic Schools for approved driver improvement courses) and I must present proof of completion to the Clerk & Comptroller within 60 days from the date this election is received by the Clerk & Comptroller.

I understand that if I satisfactorily complete this election:

My driver’s record will not reflect a conviction; and

Points will not be assessed against my driver’s license.

I understand that if I fail to complete any requirement of this election or I am ineligible for this election:

I will be guilty of the offense and my driver’s record will be changed to show a conviction of this offense; and

Points will be assessed against my driver’s license; and

Additional fines, costs, and fees will be due.

Notice: Do not sign this election unless you are sure you understand all of the conditions for a driver improvement course election. Failure to comply with the conditions will result in suspension of your driver’s license. No extensions or exceptions can be made.

My signature indicates my intent to elect to attend a driver improvement course. By signing this form, I understand that I must complete the class and present my proof of completion to the Clerk & Comptroller or pay additional fees and points will be assessed on my record.

Signature:Date:

Printed Name:

Phone Number:

Address:City/State/Zip:

Your civil penalty fee and election form must be filed with the Clerk & Comptroller’s Traffic Department within 30 days from the date the ticket was issued.

You are responsible for providing proof of completion by submitting the certificate to one of the addresses listed below within 60 calendar days from the date this election is received by the Clerk & Comptroller’s Office.

Certificates received after 60 calendar days will not be accepted and delinquency and penalty fees will apply.

Reply to the Office of Paula S. O'Neil, Clerk & Comptroller:

Robert D. Sumner Judicial Center, 38053 Live Oak Ave., Suite 112, Dade City, FL 33523-3894 West Pasco Judicial Center,7530 Little Rd, Suite 101, P.O. Box 338, New Port Richey, FL 34656-0338

Internet Form DDS Election

R072413