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Request for Payment Arrangement, Resulting in a Conviction

  1. This form allows you to make your plea of guilty or no contest and request an extension or payment plan to pay the judgment that will be entered, resulting in a CONVICTION.

  2. IF YOU REQUEST A PAYMENT PLAN, we will determine a monthly minimum payment based off of your balance. You will be subject to a one-time $15 additional fee for EACH violation, required by the state. After submitting this form, you will be redirected to make a $75 down payment that is required to start a payment plan.

  3. IF YOU REQUEST AN EXTENSION, you will have 30 days to pay the fine in full. On day 31, a $15 additional fee will be added.

  4. IF YOU ARE UNABLE TO PAY, DO NOT USE THIS FORM. Please use the form titled “Request for Indigency (Inability to Pay)”.

  5. Your submission date will reflect the date the plea and request is filed with the court. Please allow up to 3-5 days for court staff to process your request.

  6. If you have multiple citations you would like to include in your extension or payment plan, you must list all of the citations below and provide a plea for each.

  7. Plea*

  8. Do you have another violation to add?*

  9. Plea

  10. Do you have another violation to add?

  11. Plea

  12. Do you have another violation to add?

  13. Plea

  14. Do you have another violation to add?

  15. Plea

  16. Do you have another violation to add?

  17. Plea

  18. Do you have another violation to add?

  19. I swear or affirm that the following statements are true:*

  20. Upon submission of this form, your request will be reviewed by the court staff and you will be contacted by email once a determination has been reached. If you are not eligible you will receive an email to that fact.

  21. Leave This Blank:

  22. This field is not part of the form submission.