CR-228, Rev. 08/17 STATE OF MAINE ! UNIFIED CRIMINAL DOCKET County: ! SUPERIOR COURT Location: ! DISTRICT COURT Docket No: STATE OF MAINE V. Request for Fine Payment Modification or Extension of Time to Pay Fine 17-A M.R.S.244 1303-B Defendant My name is and I reside at . My telephone number is :. Please note: Do not list your address or phone number if the court has previously granted your request to keep your address and phone number confidential and not subject to public review. Ask for Form CR-011 instead. I am requesting an extension on the deadline for the payment of my fine(s). Total of all fines owed: . Date Fines Due: The reason(s) I am requesting a fine extension/modification is/are as follows: At the present time I am: ! Employed by . I make $ every ! week ! month ! two weeks. ! Unemployed and receive $a week in unemployment compensation. ! Disabled and receive $a month in disability income. ! Unemployed and receive $per month in TANF benefits. ! Unemployed but expect to start working on and expect to make $ every ! week ! month ! two weeks. ! Am currently expecting a ! State or ! Federal Tax refund in the total amount of $. ! Have no source of income. ! Have $ cash in my possession. Choose One: ! I request that the Court grant me more days to pay my fine in full. ! I request a new repayment plan of $ every ! week ! two weeks ! month beginning (date). I UNDERSTAND THAT THIS REQUEST WILL BE PRESENTED TO THE COURT FOR REVIEW. I FURTHER UNDERSTAND THAT UNLESS THE COURT GRANTS MY REQUEST BEFORE THE DATE OF THE HEARING, I MUST RETURN TO COURT ON AT FOR A HEARING. l understand the information on this form, including when I must appear again in Court, and I swear the information provided on this form is true to the best of my knowledge. Date: Defendant325s Signature Sworn to Before Me-Asst.,/Associate/Deputy Clerk ORDER ! The request for an extension of time is granted. A new fine payment order shall issue. ! Defendant shall appear for a hearing on this request on at am/pm. Date: Judge/Justice American LegalNet, Inc. www.FormsWorkFlow.com