Certificate of Compliance with Deferred Order
CAUSE NO. ______________
STATE OF TEXAS
VS.
______________________________, DEFENDANT
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IN THE MUNICIPAL COURT NO. 1
TOWN OF ADDISON
COUNTY OF DALLAS, TEXAS
Statement of Compliance
and
Request for Dismissal
I, the undersigned Defendant, have been granted Deferred Disposition in connection with
the above entitled and numbered case. The deferral period ended on ____________________
and I certify that I have complied with the terms and conditions of the Order which granted
deferred disposition. I have not been arrested or issued a citation in the State of Texas for any
offense as specified by the Order during the deferral period. I further certify that I have
performed and complied with any and all special conditions (if any) as required by the Court's
Order Granting Deferred Disposition.
I understand that this Statement of Compliance must be returned to the Court within 15
days after the end of the Deferral Period. Upon Court approval the case will be dismissed and
will NOT be reported as a conviction. I further understand that failure to comply with the terms
and conditions of the Order or falsification of this Statement will result in a CONVICTION and the
offense will be reported as required by law.
Signed on this the _____ day of ____________________, 200___
_______________________
Defendant Name (printed)
Signature
__________________________
Defendant
SWORN TO before me, on this the _____ day of ____________________, 200___.
____________________________
Notary Public in and for the
State of Texas
TO: Presiding Judge
Addison Municipal Court
P.O. Box 9010
Addison, TX 75001-9010