Motion for Waiver of DPS Surcharge
Stephen L. Hamilton
CAUSE NO. _______________
STATE OF TEXAS	§	IN THE COUNTY COURT
	§	
vs.	§	AT LAW NO. _____
	§	
_______________________	§	_____________ COUNTY, TEXAS

MOTION FOR WAIVER OF DPS SURCHARGE
	COMES NOW THE DEFENDANT in the above-styled and numbered cause and moves the Court to waive the surcharge imposed by the Department of Public Safety in this case pursuant to §708.158 of the Transportation Code.
1.	On September 1, 2011, ________ in the above-entitled and numbered cause entered a plea of guilty to the offense of driving while intoxicated. (See Exhibit A.)
2.	Defendant is indigent and offers as proof the following information for this Court:
	
_____ A copy of Defendant’s most recent tax return, which reflects that Defendant’s income or personal income does not exceed 125 percent of the applicable income level established by the federal poverty guidelines OR
	
_____ A copy of Defendant’s most recent statement of wages showing that Defendant’s income or household income does not exceed 125 percent of the applicable income level established by the federal poverty guidelines OR
	
______ Documentation from a federal agency, state agency, or school district indicating that Defendant receives assistance from the food stamp program or the financial assistance program established under Chapter 31 of the Human Resources Code OR the federal special supplemental nutrition program for women, infants, and children authorized by 42 U.S.C. Section 1786 OR the medical assistance program under Chapter 32 of the Human Resources Code OR the child health plan program under Chapter 62 of the Health and Safety Code OR the national free or reduced-price lunch program established under 42 U.S.C. section 1751 et seq. OR
	
______ Documentation from a federal agency, state agency, or school district indicating that Defendant is a dependent as defined by Section 152 of the Internal Revenue Code of 1986, and the taxpayer claiming the person as a dependant receives assistance from the food stamp program or the financial assistance program established under Chapter 31 of the Human Resources Code OR the federal special supplemental nutrition program for women, infants, and children authorized by 42 U.S.C. Section 1786 OR the medical assistance program under Chapter 32 of the Human Resources Code OR the child health plan program under Chapter 62 of the Health and Safety Code OR the national free or reduced-price lunch program established under 42 U.S.C. section 1751 et seq. OR
	
______ Other documentation presented to this Court. (See attached Affidavit of Defendant)
	WHEREFORE, PREMISES CONSIDERED, Defendant prays that this Court, after consideration of the attached documentation, grant Defendant’s Motion for Waiver of DPS Surcharge or set this matter for an evidentiary hearing.

	Respectfully submitted,

	Stephen L. Hamilton, P.C.
	12002 Trafalgar, Suite 302
	Lubbock, TX 79424
	(806) 794 0394
	Fax: (806) 783-9605

	By:	_____________________________
		Stephen L. Hamilton
		State Bar No. 24007311
		Attorney for Defendant

CAUSE NO. _______________
STATE OF TEXAS	§	IN THE COUNTY COURT
	§	
vs.	§	AT LAW NO. _____
	§	
_______________________	§	_____________ COUNTY, TEXAS

ORDER WAIVING DPS SURCHARGE
	On September 1, 2011, _______________ in the above-entitled and numbered cause entered a plea of guilty to the offense of driving while intoxicated.
	Pursuant to §708.158 of the Transportation Code, this Court finds that ______________ has provided sufficient evi­dence to this Court, as required by statute, that ______________ is indigent.  Because this Court finds that ______________ is indigent, the Texas Department of Public Safety shall, therefore, waive any and all surcharges assessed under said chapter. Defendant’s Texas Driver’s License Number is ______________.
	BY ORDER OF THIS COURT, the Defendant is hereby released from all financial penalties and/or surcharges assessed by the Department of Public Safety resulting from the offense to which the Defendant pled guilty.
	THIS COURT FURTHER ORDERS that the Texas Department of Public Safety shall notify any and all agents, public or private, who are contracted by said Department, to cease and desist all collection efforts against the Defendant for any and all surcharges associated with the above-entitled and numbered cause.

	SIGNED on _____________________________

	________________________________________
	JUDGE PRESIDING