Request for Extension of Penalty Payment Date

REQUEST FOR EXTENSION OF PENALTY PAYMENT DATE

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Citation/ Case Number*
  Ticket Showing Citation
Name *
 
Address *
 
Apt Number 
City *
 
State *
 
Zip *
 
Email *
   
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Phone *
 

I acknowledge, pursuant to Fla. R. Traf. Ct. 6.480(b) and Administrative Order 18-02-S Amended, that I am entitled to a one (1) time extension of thirty (30) days for payment of any penalty imposed in this matter. I also acknowledge that, by requesting an extension for payment, I am waiving my right to elect school pursuant to Fla. R. Traf. Ct. 6.330.


Type your full name into the signature field below to digitally sign.

Defendant's Signature /s*
 

By submitting this form online, you are accepting electronic service of all future documents filed on your case to the email address provided.



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