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2. IN THE COUNTY COURT OF THE FIFTH JUDICIAL CIRCUIT IN AND FOR 
   CITRUS COUNTY, FLORIDA

4. Citation Number*

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6. STATE OF FLORIDA
   VS

8. Defendant's Name*

10. MOTION TO ACCEPT A PLEA OF NO CONTEST AND REQUEST FOR WITHHOLD OF ADJUDICATION

12. I do hereby plea NO CONTEST to the above-referenced citation and ask the Court to Withhold Adjudication. 

    If my request is granted, I understand the following:  

    • I am waiving my right to a hearing and the Judge will review my citation and driving record to make a ruling  
    • No points will be assessed to my driving record  
    • I will receive the Judge’s order by email or U.S. mail and payment is to be made with the Clerk of Court  
    • I may be assessed additional court costs – the Court may impose court costs up to $500 except in cases of unlawful speed in a school zone, unlawful speed in a construction zone, or involving a death, the civil penalty may not exceed $1,000  
    • I may be ordered to attend either Defensive Driving School or the Advanced Driving Institute 

    Payment is not required at this time. Upon receiving the Judge’s order, payment is required within 30 days from the date of the order to avoid delinquency action including but not limited to the suspension of your driver’s license.

    
    

14. Telephone Number
15. Email Address
17. Mailing Address*
19. City*
20. State*
21. Zip Code*
23. Driver's License Number*
25. Under penalties of perjury, I declare that I have read the foregoing plea and that the facts stated in it are true*

    Please enter your full legal name in the box above

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

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