SUPERIOR COURT OF CALIFORNIA, COUNTY OF AMADOR 500 Argonaut Lane Jackson, CA 95642 209-257-2605 www.amadorcourt.org PLAINTIFF: DEFENDANT: FOR COURT USE ONLY People of the State of California ORDER ON ABILITY TO PAY DETERMINATION CASE NUMBER: Person who asked the court for an ability to pay determination: Name: _______________________________________________________________________ Street or mailing address: _________________________________________________________ City: ___________________________________________State: _______ Zip: ______________ Lawyer, if person in has one (name, address, phone number, e-mail, and State Bar number): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ A request for an ability to pay determination was filed on (date): ____________________________ The court made a previous ability to pay determination in this case on (date):_______________ Read this form carefully. All checked boxes are court orders IT IS SO ORDERED: affirmed, due within 30 days of the date of mailing of this notice, or Fine of $ Due by: ___________________________________________________________________________ Monthly payments of $ Defendant to appear in court on to be paid to the court by the at of every month. __.m. in Dept: _____________. Denied. The court has determined the defendant has the ability to pay. Payments may be arranged through the Traffic Department. Other: Dated: JUDICIAL OFFICER OF THE SUPERIOR COURT CLERK'S CERTIFICATE OF SERVICE I certify that I am not involved in this case and (check one): I handed a copy of this order to the party and attorney, if any, listed in A certificate of mailing is attached. and , at the court, on the date below. This order was mailed first class, postage paid, to the party and attorney, if any, at the address listed in and , from Jackson, California on (date) __________________________. Date: ___________________ TRF-326 [New March, 2017] Approved for optional use www.amadorcourt.org Rob Klotz, Clerk of the Court, By ORDER ON ABILITY TO PAY DETERMINATION , Deputy American LegalNet, Inc. www.FormsWorkFlow.com