Driver Improvement School Affadavit

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) attend and complete a DHSMV-approved driver improvement school; and (2) 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.

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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 a $16.00 late fee, 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