IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) v. Case No. ELECTION TO OPT-OUT OF COURT RESTITUTION COLLECTIONS I do not want the Alaska Court System to attempt to collect the restitution judgment that is owed to me in the case noted above. I understand that by making this choice, I will be able to collect the restitution judgment amount myself using the court's standard postjudgment execution procedures available at my local court. Date Signature Type or Print Name Street Address or P.O. Box City Email Address State Zip Code Phone Number Click here to E-mail to Alaska Court System or Print and mail to: Restitution Unit Alaska Court System 820 W. 4th Avenue Anchorage, AK 99501 FOR COURT USE ONLY Court Clerk Instructions: Forward this form to Fiscal Operations Restitution Unit for further processing. Clerk's Initials � TF-957 (3/17)(cs) ELECTION TO OPT-OUT OF COURT RESTITUTION COLLECTIONS American LegalNet, Inc. www.FormsWorkFlow.com