SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS (Vehicle Code, � 40510.5) TO BE FILLED OUT BY A COURT CLERK Read carefully and, if you agree, sign and return the form to the clerk. 1. I am the defendant in this case and I have been charged with the following infraction violation of the Vehicle Code that does not require me to go into court: a. � b. � c. � d. � CITATION NUMBER: CASE NUMBER: e. � 2. My court appearance date has not expired and I am providing proof of correction for correctable violations. 3. I want to pay and forfeit bail for the violation(s) listed above, but I am not able to pay the entire amount at the present time. I ask the court to allow me to pay in installments. I understand that the court does not have to allow me to make installment payments. 4. I understand that by signing below I will be convicted today of each violation that has no proof of correction. 5. TERMS OF THE AGREEMENT: The total bail (including penalties plus an administrative fee of $ to pay in installments) is $ I agree to pay the total amount as follows: $ (10 percent or more) immediately and installments of at least $ ( ) each month, starting (date): ( ) Other (explain): I agree that: All payments must be made by the due date and there is no grace period. If I do not make a payment on time, I may have to pay the rest of my unpaid bail immediately. If I do not make my payments by each due date, I will see the clerk on the next court day after the due date of the missed payment. I understand that if I do not make the payment by each due date, I may be charged with a misdemeanor under Vehicle Code section 40508, be charged up to $300 under Penal Code section 1214.1 or have a warrant issued for my arrest, and the court may impound my driver's license and place a hold on the license. The court also may assign my case to a collection agency or the State Franchise Tax Board for collection. I understand that my case will continue to be open until the date that my last installment is paid. On if I pay as agreed, all amounts due will be paid. At that time, if proof of correction has been filed with the clerk as required, my bail forfeiture will be complete and no further proceedings will be held in this matter. By signing below I declare that I have read and understand my rights printed on the reverse side, which I now choose to give up, and that I have read, understand, and accept the terms and consequences stated above. , and by the due: day of each month until paid in full. (SIGNATURE OF DEFENDANT) (DATE) (TYPE OR PRINT NAME) (ADDRESS) (DRIVER'S LICENSE/ID NUMBER) (EXP. DATE) (CITY, STATE, AND ZIP CODE) CLERK OF THE SUPERIOR COURT ACCEPTED (date): Form Adopted for Mandatory Use Judicial Council of California TR-300 [Rev. June 26, 2015] BY: (DEPUTY CLERK) Vehicle Code, � 40510.5 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS (Traffic Infractions) 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 without deposit of bail for formal arraignment, plea, and sentencing; To request and have a court trial without deposit of bail, unless the court orders bail, and challenge the charges; To have a speedy court trial and have the charges dismissed if a speedy trial is requested but not provided; To be represented by an attorney at your expense; To subpoena or 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. TR-300 [Rev. June 26, 2015] AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS (Traffic Infractions) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com