Local Court Form 226 Mandatory Distribution: Original 226 White Defendant 226 Yellow TR-123 Rev. 2/16/17 Superior Court of California, County of Contra Costa PITTSBURG 1000 CENTER DRIVE PITTSBURG, CA 94565 RICHMOND 100 37TH STREET RICHMOND, CA 94805 WALNUT CREEK 640 YGNACIO VALLEY ROAD WALNUT CREEK, CA 94596 WRITTEN PLEA FORM AND REQUEST FOR MONTHLY PAYMENTS NAME: DOCKET/CASE# ADDRESS: With regard to the Traffic Citation I received I have certain rights. In order to enter a plea I must give up these rights. I HAVE THE FOLLOWING RIGHTS: (COUNSEL) Right to retain private counsel at your own expense. (CONTINUANCE) Right to a reasonable continuance. (SPEEDY TRIAL) Right to a speedy and public trial. (COURT TRIAL) Right to a court trial. (SELF INCRIMINATION) Right against self incrimination and to remain silent. (CONFRONTATION) Right to see and confront witnesses against you and to cross examine them. (SUBPOENA) Right to subpoena witnesses and evidence. (PLEA) Right to plead guilty, no contest or not guilty. INITIAL NEXT TO ALL THAT APPLY: I have read and understand each of my rights as listed above. I hereby waive each of my rights as listed above. I hereby freely and voluntarily submit a plea of (guilty / no contest) to each charge on the citation. (CIRCLE ONE). I understand that the fine amount for my citation is: $ Fine $ Traffic School $ Total (To be completed by the Court Clerk) (Eligible & Due: / / ) I request traffic school, if eligible. I understand that my case and this plea form will be submitted to the Court and if accepted I will be found guilty of each charge on my citation and will be assessed the indicated fine. If the Commissioner does not agree with the fine amount or the plea, the form will be returned to me and I will have all of the rights listed above as I proceed with this case. Date (Signature) Petition for payment of Fine through Installments I understand that if the Court Accepts my plea, my case will be referred to the Court222s third party collection agency, AllianceOne, and a $30 processing fee will be assessed unless I pay my fine in full. I must contact AllianceOne, within one week from today to arrange a payment plan. The minimum agreed payment must be paid each month by the due date. If my payment is not received by AllianceOne by the due date each month, my case will proceed to a 223failure to pay224 status and an additional $300 Civil Assessment and a $15 FTP fee will be added. A hold may be placed on my driver222s license and a $10 administration fee may be added. ALLIANCEONE 1-877-541-8420 (Print name) P.O. Box 11641 Tacoma, WA 98411 https:/secure.allianceoneinc.com (Signature) Date ORDER re. Request for Entry of Plea (COURT USE ONLY) The Court having read and considered the above waiver of rights and request to enter Plea hereby makes the following order: The Defendant has knowingly and intelligently waived his/her rights and understands the consequences of his/her plea. The plea is accepted, the defendant is found guilty of each charge and the fine is set at: $. The defendant is found eligible / not eligible (Circle one) for Traffic School Signature Date Commissioner American LegalNet, Inc. www.FormsWorkFlow.com