MUNICIPAL COURT
104 GRADY TUCK • BASTROP, TEXAS 78602

1. ___I plead NOLO CONTENDERE and enclose fine.
2. ___I plead GUILTY and enclose fine.
3. ___I plead NOT GUILTY and request a trial by Jury.
4. ___I plead NOT GUILTY and waive my right to Jury Trial and request a Trial           before the Court/Judge

Attorney’s Name and Phone Number:
____________________________________________
(if you will be represented by counsel)

DATE ____________

STREET ADDRESS __________________________________

CITY ____________________STATE ___________ZIP ______________

HOME PHONE _____________WORK PHONE ____________

SIGNATURE ___________________________________

PRINT NAME __________________________________