Microsoft Word - Amnesty installment agreement for fines
SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE:BRANCH NAME:PEOPLE OF THE STATE OF CALIFORNIAvs.DEFENDANT:AGREEMENT TO PAY FINE, PENALTIES, AND FEES IN INSTALLMENTS (Amnesty Reduction for Failure to Pay after Judgment) CITATION NUMBER:CASE NUMBER:Read carefully and, if you agree, sign and return the form.1. I am the defendant in this case and I have been sentenced for the following infraction violations:a. b. c. d. e. 2. My court appearance date has expired.3. I want to pay for the violation(s) listed above, but I am not able to pay the entire amount at the present time.I request that payment be accepted in installments.4. I understand that by signing below I agree to pay the fine, penalties, and fees for a conviction of the listed violation(s).5. TERMS OF THE AGREEMENT:The total owed (including an administrative fee of $50) is $ I agree to pay the total amount as follows:$ due immediately and installments of at least $ due:( ) each month, starting (date): and by the day of each month until paid in full. ( ) Other (explain): I agree that: All payments must be made by the due date and there is no grace period.If I do not make a payment on time, I may have to pay the rest of my unpaid debt immediately.If I do not make my payments by each due date, I will return on the next business day after the due date of the missed payment to explain the reason for the failure to pay.I understand that if I do not make the payment by each due date, I may be charged with a misdemeanor under Vehicle Code section 40508, have a warrant issued for my arrest, and the court may assign my case to a collection agency or the State Franchise Tax Board for collection.I understand that my case will continue to be open until the date that my last installment is paid. On , if I pay as agreed, all amounts due will be paid. At that time my payment will be complete and no further proceedings will be held in this matter.By signing below I declare that I have read, understand, and accept the terms and consequences stated above. (SIGNATURE OF DEFENDANT)(DATE)(TYPE OR PRINT NAME)(ADDRESS)(DRIVER'S LICENSE/ID NUMBER)(EXP. DATE)(CITY, STATE, AND ZIP CODE)ACCEPTED (date): BY:AGREEMENT TO PAY FINE, PENALTIES, AND FEES IN INSTALLMENTS (Amnesty Reduction for Failure to Pay after Judgment) Amnesty-Fine ................
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