EXTENSION CONTRACT - Municipal Online Services

[Pages:1]EXTENSION CONTRACT

Ticket No. ______________

Cause No. ________________

STATE OF TEXAS

VS. _____________________

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IN THE MUNICIPAL COURT

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CITY OF GALVESTON

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GALVESTON COUNTY, TEXAS

I, the undersigned, am the defendant in the above styled and numbered cause and I hereby enter my plea of guilty/no contest to the offense listed on my citation.

Upon signed agreement I waive my right to a jury trial and my right to appeal. The Court after accepting my plea and having found me guilty I hereby agree to pay, in full, my fine and court costs by 30 days from today's date, in the amount of $________. In order to qualify for a payment contract you must fully complete this form. A driver's license or picture ID is required along with your fingerprint.

Upon signed agreement of this contract, I am ordered and agree to pay in full the above amount to the Galveston Municipal Court Office at 601 54th Street, Suite 300, Galveston, Texas 77551 on or before 30 days from today's date

FOR YOUR CONVENIENCE YOU MAY MAKE PAYMENT BY CALLING 1-800-5308084 or ONLINE at galvestontx

I UNDERSTAND THAT IF I VIOLATE THE TERMS OF MY PAYMENT CONTRACT IN ANY MANNER, A CAPIAS PROFINE WARRANT WILL BE ISSUED FOR MY ARREST.

I acknowledge that I fully understand all of the provisions of this agreement and agree to fully comply with the same. I have been furnished with a copy of this agreement.

________________________________________________ Signed: _________________ Defendant's Signature

BY:______________________________________________( permission attached)

IT IS HEREBY ORDERED that the Defendant make payment as noted above. Each payment will be due and payable as scheduled until the total amount due is paid to the Court.

_______________________________________________ Signed: ________________ Galveston Municipal Court Judge

AMOUNT DUE: $______ Thumbprint:

PLACE OF EMPLOYMENT: _________________ Address: __________________________________ Phone #: __________________________________

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