Exempt From VRA Certif. IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA Plaintiff, vs. ) ) ) ) ) ) ) ) ) ) ) CASE NO. CR Defendant. REQUEST FOR PAYMENT SCHEDULE OR REDUCTION IN AMOUNT OWED A Judgment for Cost of Appointed Counsel was entered against me in the amount of $ . I still owe $ . Payment of this amount would impose hardship on me or my immediate family because Therefore, I request that the court: allow me to make payments on the judgment on the following payment schedule: Payment Amount: $ Due: Monthly Weekly Other: Date of First Payment: defer payment of the judgment until: reduce the amount of the judgment to $ . (You must attach supporting documents to justify reducing the judgment amount.) Date I certify that on a copy of this request was sent to the plaintiff's collections office. Clerk: Defendant's Signature Mailing Address City State ZIP PROSCECUTING AUTHORITY'S STATEMENT OF AMOUNT DUE (The prosecuting authority should submit a balance due on the judgment within 10 days after distribution of the above Request. The attorney for the prosecuting authority may file a separate response.) Balance due on judgment as of (Date) $ Date Signature Print Name and Title CR-545 (6/92) REQUEST FOR PAYMENT SCHEDULE OR REDUCTION Crim. Rule 39(c)(2)(C) American LegalNet, Inc. www.FormsWorkFlow.com