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TO DEPARTMENT OF PUBLIC SAFETY PO BOX 15999 AUSTIN TX 78761-5999 Accident Case No. NOTICE OF DEFAULT ON COURT APPROVED INSTALLMENT AGREEMENT The undersigned or Judgment Creditor hereby certified that Attorney for Judgment Creditor an installment agreement authorized in Cause No. in the County Texas on the action styled Court day of vs in a civil is now in default. In that the installment debtor has defaulted in the payment of one or more installment payments that there is now accrued unpaid and due on said court approved installment agreement the remaining unpaid principal sum of. In certifying to the above facts request is hereby made to the Department of Public Safety to enforce the Texas Motor Vehicle Safety Responsibility Act as authorized under the provisions of Section 601. 336. Proceedings was rendered as the result of a suit instituted on and was obtained as a result of a motor vehicle accident which occurred on on a public highway at or near The names driver license numbers dates of birth registration numbers and mailing addresses of the judgment debtors are Name First Middle Last DL Number Street or PO Box Date of Birth City State Registration No* Zip Code The mailing address of the judgment creditor is Witness my hand this Address of Attorney Type Name of Attorney for Judgment Creditor SR-46 Rev* 02/03 Phone No*. In certifying to the above facts request is hereby made to the Department of Public Safety to enforce the Texas Motor Vehicle Safety Responsibility Act as authorized under the provisions of Section 601. 336. Proceedings was rendered as the result of a suit instituted on and was obtained as a result of a motor vehicle accident which occurred on on a public highway at or near The names driver license numbers dates of birth registration numbers and mailing addresses of the judgment debtors are Name First Middle Last DL Number Street or PO Box Date of Birth City State Registration No* Zip Code The mailing address of the judgment creditor is Witness my hand this Address of Attorney Type Name of Attorney for Judgment Creditor SR-46 Rev* 02/03 Phone No*..

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