Steuben County Driver Diversion Program Form – Fill Out and Use This PDF

Steuben County District Attorney s Office

Driver Safety Diversion and Reduction Program Affidavit / Application

Please READ the DA s Office

Driver Safety Diversion and Reduction Program

Information Packet

DO NOT call our office until you have READ the packet

This information is located on our website under http://www.steubencony.org/Pages.asp?PGID=69

If your traffic ticket in considered a NON-Moving Violation, please proceed to the Affidavit/Application on the next page and our office will consider your request for reduction.

Moving Violation requests for reduction must go through this process, unless represented by an attorney of law.

Again DO NOT call our office until you have READ the information packet, located at the web address above.

SCDADSDP Application Form: Revised 2014-04-08

Steuben County District Attorney s Office

Driver Safety Diversion and Reduction Program Affidavit / Application

Name:Address:

Email/Phone:

Town of Offense(s) Occurred:

What was the ticket(s) for:

This traffic ticket is a NON-Moving violation ticket. At this time I request a possible reduction WITHOUT the accessed ADMINISTRATION FEE. Please COMPLETE the whole application to be considered.

I,_________ the defendant, born on ______________ request to participate in the

Steuben County Driver Safety Diversion and Reduction Program to avoid points and penalties associated with my traffic infraction(s). I understand that my acceptance into the program is discretionary and is decided by the program. I hereby apply as a participant in the Driver Safety Diversion and Reduction Program and waive my speedy trail rights.

I, further understand that there is an accessed ADMINISTRATION FEE of either two hundred and fifty dollars ($250.00) or one hundred and fifty dollars ($150.00), and if notified of acceptance into the program. I will be required to submit the accessed administration fee along with the Course Attendance Form, in order to be admitted into the program.

Application Questions: Please answer the following questions, Yes or No

False statements made in the foregoing instrument are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law.

1.Have you been convicted of driving under the influence offenses (DWI, DWAI, DWAI-Drugs), Vehicular Homicide, Involuntary Manslaughter, within the past 10 years? Yes _______ or No ______

2.Have you been convicted of any traffic related offenses within the last 18 months? Yes ______ or No ______

3.At the time of the offense were you operating the motor vehicle with either a suspended driver s license or suspended insurance? Yes ______ or No ______

4.Were you involved in an accident at the time of the offense? Yes ____ or No ____. If YES please include an insurance claim report of all payouts made to people involved in the accident in question. Contact your insurance agent for report

Mitigating Circumstances

The defendant states that at the time of the offense, one or more of the above statements were marked YES. Please give a brief statement to the circumstances. At this time I would like to request a review for the online course due to the following reasons. Use the back of this sheet for additional space if necessary.

All Defendants must send :		To: Steuben County District Attorney s Office
1.	This application ; completed	Attn: Driver Safety Diversion and Reduction Program
2.	A copy of the traffic ticket(s);	3 East Pulteney Square
3.	Abstract of Driving Record from your state DMV	Bath, NY 14810
	http://dmv.ny.gov/dmv-records/get-my-own-
	driving-record-abstract
4.	A self-addressed stamped envelope

**You will be notified by mail or email within 15 to 20 days if you are accepted into the program.**

DO NOT call the DA s Office in regards to the status of your application until 15 days after mailing.

***False statements made in the foregoing instrument are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law. Accordingly and with notice of the foregoing I hereby affirm that the foregoing statements are true, under penalty of perjury this ______ day of ________________, 20___.***

_____________________________________	_____________________________________________
SIGNATURE OF DEFENDANT	PRINT NAME OF DEFENDANT
SCDADSDP Application Form: Revised 2014-04-08