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2. *** Disclaimer***
   This is a request for the Plea of Guilty Without Personal Appearance Payment Plan Program **You must have a valid email address to participate in the program** Once submitted, the court will email you the completed document for your review and signature.
4. Plea Payment Plan
   This is a 90-day payment plan. The initial $110.00 is due within 3 days of receipt of the signed document. If the payment is not made within that time, the plan goes into default and the plea amount will be due in full. Failure to pay may result in your license being suspended or a warrant issued for your arrest.
6. Date *
   Date
7. Citation Number *
9. First Name*
10. Last Name*
12. Address
14. City
15. State
16. Zip Code
18. Phone Number*
20. Email Address*
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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