Request for Extension of Penalty Payment Date

REQUEST FOR EXTENSION OF PENALTY PAYMENT DATE

Fields marked with an * are required

Citation/ Case Number*

Name *

Address *

Apt Number

City *

State *

Zip *

Email *

Confirm Email

This address will be used to communicate important information.

Phone *

Check here if we may text this number.

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.

Server:PUBWEB03