County, Colorado County Court District Court



County Court District Court

Larimer County, Colorado

Court Address:

Larimer County Justice Center

201 LaPorte Ave, Suite 100

Fort Collins, Colorado 80521

PEOPLE OF THE STATE OF COLORADO vs.

Defendant:

     

|

COURT USE ONLY | |

|Attorney or Party Without Attorney (Name and Address): |Case Number:       |

|      |ML Number:       |

|      |SID Number:       |

|      |Division/Courtroom |

|Phone Number:       E-mail:       | |

|FAX Number:       Atty. Reg.#:       | |

|NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM |

Pursuant to Article 16, Title 18.5, Section 107 of the Colorado Revised Statutes, as amended, the below named person(s) (or entity) hereby notifies the Court, the Collections Investigator, and the Department of Corrections, if defendant was sentenced thereto, of his or her WITHDRAWAL of intent to pursue collection of restitution in his or her own name. It is further stated that:

1. The below named person(s) is a victim in whose name a restitution order has been entered by this court.

2. That such order was entered on       (date of order).

3. That the amount of outstanding restitution still owed to this victim as shown by the victim’s record is $      (attach documentation of defendant’s payments to victim).

4. That the below named person(s) wishes to exercise his or her right to withdraw from pursuit of collection of restitution in his or her own name pursuant to Section16-18.5-107(4) C.R.S.

5. That the Notice of Intent to Pursue Collection by Victim was delivered to the Clerk of the Court or, if the Defendant was sentenced to the Department of Corrections, to the Executive Director of the Department of Corrections on       (date delivered).

6. That upon receipt of this Notice of Withdrawal the Collections Investigator or the Department of Corrections shall pursue collection of restitution pursuant to Article 18.5, Title 16, C.R.S.

Dated:       (today’s date) _____________________________________

Signature of Victim

_________________________________      

Typed/Printed Name of Victim

My Commission Expires:       Address:      

Telephone:      

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