Traffic Infraction Deferral Application

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By clicking the SUBMIT button, I hereby request permission to enter into your traffic deferral program and voluntarily furnish the following information for your use in determining my eligibility. It is my responsibility to verify this application is received by the Morgan County Prosecutor’s Office.

(By electronically signing and submitting this document, you are affirming that everything stated herein is true and accurate to the best of your knowledge.)

**If our office determines that you are eligible for the deferral program, we will email (or mail) you the agreement that must be read, initial and signed. You must then return the completed agreement to the court along with your fee by the date listed in paragraph number 5. Failure to do so may cause your license to be suspended.**

* Denotes a required field

Do you have any other charges pending in any other court?*

Yes

If yes, what charges and in what court/County?

First Name*

Last Name*

Please Do Not Complete The Following Field

Address*

Address 2

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Date of Birth*

MonthDay Year,

Driver's License No. (Letters & Numbers only. No dashes or spaces)*

Email*

Ticket or UTT No.*

Ticket or UTT date issued*

MonthDay Year,

Was this ticket received as a result of an automobile accident?*

Yes

Electronic Signature*

Today's Date*

MonthDay Year,

Traffic Infraction Deferral Application

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