CLERK’S NOTICE OF INES AND COSTS
CLERK’S NOTICE OF FINES AND COSTS Case No.
COMMONWEALTH OF VIRIGNIA Va. Code §§ 19.2-354, 19.2-358, 46.2-395
, Circuit Court
DEFENDANT:
You are responsible for the following fines, costs, forfeitures, restitution, and/or penalties. Interest begins to accrue forty (40) days after the due date. ALL FINES, COSTS, FORFEITURES, RESTITUTION, AND/OR PENALTIES ARE DUE ON DATE OF JUDGMENT UNLESS DELAY IS GRANTED.
If you fail to pay the following fines, costs, forfeitures, restitution, and/or penalties by the date of judgment, or if you are allowed to make installment payments or a deferred payment with the consent of the Court, and fail to make such scheduled payment(s), the Clerk is required to report such failure to the Court, the Department of Motor Vehicles, the Department of Taxation, the State Compensation Board and the Attorney for the Commonwealth. In addition, a capias may be issued for your arrest and you may be subject to any one or more of the following:
1. the Court may impose additional fines and/or imprisonment;
2. the Court may revoke part or all of any suspended sentence;
3. your fines, costs, forfeitures, restitution and/or penalties will be offset against any tax refund, lottery winnings or other funds due you from the Commonwealth;
4. your driver’s license will be automatically suspended effective ten days from date of conviction or immediately after the due date of a missed payment or ten days following notice that a check or credit card payment has been dishonored by the bank or issuing institution;
5. DMV will revoke your automobile registration certificate and plates and/or refuse to issue new registration or plates until fines, costs, forfeitures, restitution and/or penalties are paid;
6. collection procedures will be undertaken to subject your property to the payment of the costs, fines, forfeitures, restitution and/or penalties due;
7. the Court will revoke any privileges you may have to serve all or part of your sentence in a home/electronic incarceration program or to participate in any work-release or non-consecutive days program.
DATE OF JUDGMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 $ _________ 110 $ _________
112 $ _________ 113 $ _________
119 $ _________ 120 $ _________
DEFERRED PAY DUE DATE: . . . . . . . . . . . . . . . . . . . . . . . 121 $ _________ 132 $ _________
. . . . . . . . . . . . . . . . . . . . . . . 133 $ _________ 137 $ _________
MAY PAY IN INSTALLMENTS: Ž Yes Ž No 140 $ _________ 143 $ _________
181 $ _________ 203 $ _________
206 $ _________ 229 $ _________
260 $ _________ 265 $ _________
305 $ _________ 410 $ _________
450 $ _________ 451 $ _________
452 $ _________ 452 $ _________
520 $ _________ ___ $ _________
NOTE: Fees not shown in total shown at right: ___ $ _________ ___ $ _________
ŽCourt reporter fees GROSS DUE: $____________________
ŽCourt-appointed attorney fees (see note at left)
CASH BOND TO BE APPLIED TO FINES AND COSTS: $_______________
(Va. Code §§ 19.2-121, 19.2-369 AND 19.2-386.1) NET DUE: $_______________
COPY OF THE ABOVE DELIVERED TO THE DEFENDANT IN PERSON.
DATE: . . . . . . . . . . . . . . . . . . Defendant’s signature ______________________________________
DATE: . . . . . . . . . . . . . . . . . . _______________________________________, Bailiff/Clerk/Deputy Clerk
COPY OF THE ABOVE MAILED TO DEFENDANT AT ADDRESS IN FILE.
DATE: . . . . . . . . . . . . . . . . . . ______________________________________, Deputy Clerk
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