For Court Use Only Superior Court, County of Imperial 1625 Main Street El Centro, CA 92243 www.imperial.courts.ca.gov (760) 336-2200 People of the State of California, vs. ) ) ) ) ) ) ) Case No: Bail Forfeiture & Request for Monthly Payments Defendant, Name: Address: City/State/Zip: Drivers License #: _____________________________________________________________________________________ Initial each line below that you are agreeing to: _____ I have read and give up those rights listed on the advisement below. _____ I understand the bail amount for my citation is $. _____ My courtesy notice advised that I am eligible for traffic school and I request traffic school for an additional $55.00. Traffic school document will be provided by the clerk. _____ I wish to forfeit the bail amount by paying in monthly installments which is the equivalent of a conviction that will be placed on my driving record. I, the undersigned, agree to make payments on this case (standard amount is $50.00 per month). I traffic school promise to pay the fine of $ _______________ (including a $35.00 administrative fee), $55.00, totaling $_______________. Payments are due on or before the __________ day of each month, starting,____________________. Thereafter, I promise to pay the monthly payment on or before the due date until the remaining balance is paid in full. Failure to pay the fine as indicated above may result in the following:  A Civil Assessment in the amount of $300.00 pursuant to Penal Code 1214.1 and  VC40508.5 Civil Assessment is enforced as a civil judgment, including, but not limited to wage garnishments, tax intercepts and liens on property.  DMV being notified pursuant to VC40509.5 immediately to suspend your driving privilege pursuant to VC13365 (a)(2). This suspension will not be lifted until all fines are paid in full. Dated: ___________________ Signature: _____________________________________ PLEASE DATE, SIGN, AND MAIL ORIGINAL DOCUMENT TO COURT Advisement of Rights By choosing to pay and forfeit bail in installments and not go into court, you will be giving up these rights:  To appear in court for formal arraignment, plea and sentencing;  To have a court trial and challenge the charges;  To have a speedy court trial and have the charges dismissed if a speedy trial is requested by not provided;  To be represented by an attorney at your expense;  To subpoena and present witnesses and physical evidence using the power of the court at no cost to you and to testify on your own behalf;  To confront and cross-examine all witnesses under oath testifying against you; and  To remain silent and not testify. CR-11 Mandatory Use Adopted 01/01/2009 American LegalNet, Inc. www.FormsWorkFlow.com