Seminole County Florida Clerk of Court

Instructions:

Before beginning, please have all case numbers to be included in this payment plan.
Complete and submit this form making sure all applicable fields are filled in.
A copy of the submitted application will be sent to the email address you provide.
Once clerk has reviewed application a detailed payment schedule will be returned to you at the email address provided or they will contact you for additional information.
If you have any questions during this process, please contact us at 407-665-4300

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Signature and Initials * Required

The next page will list the Plans Terms and Failure to Comply Consequences. Each must be Accepted in order to Continue. On completion your Initials will be populated in the Final PDF Application acknowledging you have read and attest/confirm/swear to these conditions. The name as you have provided will also be used in the signature block.

Name for Signature Block*:

Initials*:

Term, Acknowledgement of Terms, and Failure to Comply Consequences

I attest/confirm/swear that the information provided on this application is true and accurate to the best of my knowledge. I will abide by the terms of the payment plan and understand failure to do so may result in the suspension of my driver's license for failure to pay a financial obligation and potentially my case(s) being referred to a collection agency and additional collection fees assessed.

I Accept

I understand that court-imposed financial obligations are penalties from my sentence and pursuant to F.S. 938.30, I am required to pay for all fines, fees, and costs incurred from my case proceeding(s).

I Accept

I wish to enroll in a payment plan per s. 28.246(4)(B), F.S.

I Accept

I understand that court-imposed financial obligations and civil penalties are penalties from my sentence or set by applicable law and I am required to pay for all fines, fees, and costs incurred from my case proceeding(s).

I Accept

I understand and agree to pay a one-time $25 or $5 per month administrative fee to establish a payment plan – (s. 28.24(27)(b) or s. 28.24(27)(c), F.S.).

If I fail to complete my payment plan and the clerk creates a new payment plan form, I understand the clerk will assess an additional $25 or $5 per month administrative fee each time a new payment agreement is established.
I further understand that nCourt charges a fee of up to 6% per payment when making payments by credit card.

I Accept

I understand that it is my responsibility to make timely payments pursuant to the plan, regardless of e-notification reminders.

Payment is due no later than 11:59 PM EST on the date given.

I Accept

I will timely update my address, cell phone number, email address and any other contact information with the Clerk's Office so that I may receive notifications.

Failing to update my contact information may prevent me from receiving payment plan notifications.

I Accept

Willfully failing to pay as agreed may result in the Florida Highway Safety and Motor Vehicles (FLHSMV) issuing an order suspending my driver license and my privilege to drive 20 days after the date the order of suspension is mailed (ss. 318.15 or 322.245, F.S.).

FLHSMV will send notification of suspension to the address they have on file.

I Accept

If I fail to establish a new payment plan, my license will remain suspended. If my case(s) remains unpaid after 90 days, my case(s) will be referred to a collection agency (s. 28.246(6), F.S.).

The collection agency may add a 25% percent fee to my outstanding balance, and I may need to pay the new balance through the collection agency.

I Accept

A failure to pay timely, which results in any criminal fine assessed by the court not being paid by the date established by the court, may result in the arrest of the defendant for failure to pay the fine.

I Accept

Criminal cases may be subject to a non-refundable lien fee of $22.00

I Accept

General Information (s. 28.246(4)(b), F.S.) * Required

(If you cannot provide all the information on this form, please contact us at 407-665-4300.)

First Name *:

Middle Name:

Last Name *:

Street Address (with apt#)*:

City*:

State*:

Zip*:

Date of Birth *:

Driver License or State ID Number *:

Case(s) to be included in Payment Plan * Required

Please Indicate Case Type(s) *:

Traffic

Misdemeaner / Felony / Criminal Traffic

Juvenile

List Case Number(s) or Citation Number(s) seperated by spaces *:

Example of Court Case Numbers: Court - 2019CF001234A Citation -

Note: Clerk may review and request additional information.

Contact Information * Required

Phone Number:

Cell Phone Number:

Email Address *:

Once plan is created how would you like Automated Payment Notification? (Data and message rates may apply.)

Can Notify Via Email

Can Notify Via Phone

Can Notify Via Text Message

Financial Information - Current or Future Assets * Required

Cash On Hand:

$

Homestead Real Estate:

Value $

Loan Balance $

Non-Homestead Real Estate:

Value $

Loan Balance $

Car/Motor Vehicle(s):

Value $

Loan Balance $

Boats/other tangible property(s):

Value $

Loan Balance $

Money Market Accounts:

$

Bank/Saving Accounts:

$

Stocks/Bonds/Certificates:

$

Future Assets Received Soon:

$

My Total Liability/Debt is:*

$

Income - Information

Total net annual income pay consists of total salary and wages, minus deductions required by law, including court-ordered support payments. – s. 27.52(1), F.S.

Current net annual income pay is:

$

Income Sources

Social Security benefits:

$

Payment Interval:

Unemployment compensation:

$

Payment Interval:

Reemployment Assistance Paid:

$

Payment Interval:

Union funds:

$

Payment Interval:

Retirement/pensions:

$

Payment Interval:

Trusts or gifts:

$

Payment Interval:

Veteran's benefits:

$

Payment Interval:

Worker's compensation:

$

Payment Interval:

Rental income:

$

Payment Interval:

Dividends or interest:

$

Payment Interval:

Support from family:

$

Payment Interval:

Other income not on list:

$

Payment Interval:

Payment Plan Options * Required

How much can you afford to pay per month?*

$

How much can you pay today for a down payment?

$

Additional Information For Clerk:

Review of Information

Form Review.

Confirmation

Form has been submitted Successfully !
You will recieve estimation on your email id and contact no.