You must fill out the form at the bottom of this page and turn into the court BEFORE or Posted-Dated (through the postal mail service) by your court date.
** Senate bill 1417 requires the court to collect $25.00 fee from a person who seeks an extension to pay the fine rather than pay immediately.
I hereby enter a plea of ( )GUILTY ( )NOLO CONTENDRE and request that I be granted a 30 day extension. I understand that there will be an ADDITIONAL FEE of $25.00 added to my original fine amount. I am also aware that it is my responsibility to contact make sure they received my request form and to get the date of when my payment is due.
Print Name____________________________________ Citation Number_____________
Signature_______________________________________ Date_____________________
Address_________________________________________ City__________________________ St.______ Zip_____________ DAY-TIME PHONE( )_______________________
THIS MUST BE TURNED IN ON OR POSTED DATED (THROUGH POSTAL SERVICE) BY YOUR ORIGINAL COURT DATE.