In the County Court
in and for
Madison County, Florida
Affidavit Of Election Of
Driver Improvement School (DIS)
If you have received a traffic
citation for an infraction within the past 30 days, you may elect to attend Driver
Improvement School under F.S. 318.14 (9). This election requires you to: (1)
pay a reduced fine; (2) attend and complete a DHSMV-approved driver improvement
school; and (3) submit proof of completion to the Clerk of the Courts within 90
days from the date the citation was issued. Upon receiving a certificate of
completion, the Clerk will withhold adjudication of guilt and no points will be
assessed against your driver’s license. If you fail to submit the certificate
of completion within 90 days, you will be required to pay the balance of the
original fine amount and a $10.00 processing fee, in accordance with F.S.
318.15(1)(b).
_________________________________________________________________________________________________
Citation #
______________________________________________________________________________________________________________
Print Name
______________________________________________________________________________________________________________
Driver’s License
No.
Affidavit
I hereby swear or affirm that I am
eligible for the option of attending driver improvement school and I understand
the requirements as stated above.
Signed this_______ day
of__________________________
______________________________________________________________________________________________________________
Signature
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Deputy Clerk / Notary Public____________________________ Date
Penalty For False Affidavit
Should the State find that you did
not meet the above stated eligibility requirements to elect the Driver
Improvement School option, your Driver’s License may be suspended, points will
be assessed, and substantial fines and fees will be imposed.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Request To Attend
Driver Improvement School (DIS)
(No Points Assessed)
4 Hour Basic
Traffic Course
Courses must be approved by the State of Florida.
Out of State completions will not be honored.
You must request this option
within 30 days of receiving the citation,
and may request this option once a year and five times in your lifetime. To
determine eligibility, you may contact the Department of Highway Safety and
Motor Vehicles (DHSMV) at (850) 922-9000.
If you are eligible
and elect the DIS option, please refer to the following instructions:
A. Fill out the “Affidavit of Election of DIS”
located on Page 2. Affidavit must be notarized.
B. Mail this Affidavit, the yellow Uniform
Traffic Citation, and your payment (see table on page 1) to the Clerk’s Office within
30 days from the date the citation was issued.
C. The signature on the election form must match
the signature of the citation.
D. Payment for the DIS class is not included in
this payment and must be paid directly to the school you select.
E. For information on DIS schools in your area,
you may look in the yellow pages of the phone book under “Driving Instruction”.
F. If your license is issued by a state other
than Florida, you must contact that state to determine if points will be
withheld for completion of DIS.
G. Upon completion of DIS class, the original
certificate of completion must be filed in the Clerk’s Office within 90
days from the date the citation was issued.
H. If you fail to submit the certificate of
completion within the 90 day time period, you will be required to pay
the amount of the fine reduction, plus a $10.00 processing fee as provided in
F.S. 318.15(1)(b). Additional points will be assessed against your license.
Notes:
(1) When sending the yellow copy of the citation, retain the citation number
for future reference; and (2) So that you complete the DIS class in a timely
manner, do not delay in signing up!
For more information,
you may call Monday–Friday, 8–5 Eastern Time
850–973–1503