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Payment Plan Request

  1. Please list any additional citation number(s) for which you want to include on a payment plan.

  2. Please enter your physical address (no PO Boxes, please. You may enter mailing address in the space provided below).

  3. Please list your cellphone number

  4. Please list your home phone or alternate phone (if applicable)

  5. Please enter your mailing address if different from your home address

  6. Please list a reference person. Person must be 17 or older and NOT live in the same household as you.

  7. Please list the reference person's best contact phone number

  8. Please list a second reference person. Person must be 17 or older and NOT live in the same household as you.

  9. Please list the second reference person's best contact phone number

  10. Please list the approximate amount of money you receive every paycheck (after taxes and other deductions have been made)

  11. How often are you paid? Weekly? Bi-weekly? Monthly?

  12. Please list any additional income you receive outside of your normal paycheck. This includes tips, alimony, social security, child support or other regular sources of support.

  13. Please list the total number of people in your household that you directly support. This includes any adults or children living in your household who rely upon your financial support. This does NOT include any children for which you are legally required to pay child support who reside in another household.

  14. Please list your estimated monthly expenses. This includes rent/mortgage, utilities, groceries/food, credit cards, child care, medical expenses, auto loans, auto insurance and phone bill

  15. Please list your estimated monthly expenses for payments you are legally required to make. This includes alimony, child support, legal fees and/or any court ordered fines and fees.

  16. Acknowledgements*

    Under penalty of perjury, I hereby certify the foregoing as being a complete and accurate statement of my current financial condition. I authorize the Compliance Department Officer of the City of Garland, to conduct a complete and thorough investigation of my statement. I understand that this investigation could include direct verification of all information given and/or the obtaining of reports from credit reporting agencies. It is with this understanding and acknowledgment that I formally request an extension of time for payment of the fine/fees and court costs now due and payable to the City of Garland.

  17. Plea*

    I understand that if there is not already a judgment entered against me, that I will plea no contest to the charge(s) against me and waive my right to a trial. I further understand that a conviction will be entered against me and reported to the Department of Public Safety (DPS) and may appear on my permanent and/or driving record.

  18. Electronic Signature*

    By checking the "I agree" box above and typing your name below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  19. For the purpose of your electronic signature

  20. The below is for Court use only. Please do not complete the below fields.

  21. This section for court use only, please do not complete

  22. This section for court use only, please do not complete.

  23. This section is for court use only, please do not complete.

  24. This section is for court use only, please do not complete.

  25. Leave This Blank:

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