Madera Superior Court Form Adopted for Optional Use MAD-TRC-0002 (Rev. 3/19/19) AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS Page 1 of 2 SUPERIOR COURT OF CALIFORNIA, COUNTY OF MADERA STREET ADDRESS: 200 South G Street MAILING ADDRESS (Same) CITY AND ZIP CODE: Madera, California 93637 BRANCH NAME: FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS (Vehicle Code, 247 40510.5) TO BE COMPLETED BY THE COURT Read carefully and, if you agree, sign and return the form to the clerk. CITATION NUMBER: CASE NUMBER: 1. I am the defendant in this case and I have been charged with the following infraction violation(s) of the Vehicle Code that do not require me to go into court: a. 247 b. 247 c. 247 d. 247 e. 247 2. My court appearance date or extension date has not passed, and I am providing proof of correction for any correctable violations. 3. I want to pay and forfeit bail for the violation(s) list above. I understand that the court does not have to allow me to make installment payments. 4. I understand that by signing below, each violation that is reportable to the Department of Motor Vehicles (DMV) and has no proof of correction will be reported as a conviction. 5. TERMS OF THE AGREEMENT: Total bail fee (including penalties and administrative fee of $35.00) is $ Initial Payment (10% minimum): $ Remaining balance after first payment: $ ( ) I agree to pay the remaining balance in monthly installments of at least $ due on the day of each month, starting on and until paid in full on or before . ( ) 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 any payment on time, I may have to pay the rest of my unpaid bail immediately. I understand that if I do not complete my payment plan the court may: Charge me with a failure to appear or pay under Vehicle Code section 40508. Charge a civil assessment of up to $300 (Pen. Code, 247 1214.1) or have a warrant issued for my arrest. Report the failure to pay to the Department of Motor Vehicles, which may suspend or place a hold on my driver222s license. Assign the case to a collection agency or the State Franchise Tax Board for collection. I understand that if I pay as agreed and if any proof of correction has been filed with the court as required, my bail forfeiture will be complete, and at the time, the case be closed. By signing below, I affirm that I have read, understood, and accepted the above terms and conditions. I also affirm that I have read and understood my rights printed on the reverse side and that I choose to give them up. (SIGNATURE OF DEFENDANT) (DATE) (TYPE OR PRINT NAME) (DRIVER222S LICENSE/ID NUMBER) (ADDRESS) (CITY, STATE AND ZIP CODE) (TELEPHONE NUMER) CLERK OF THE SUPERIOR COURT ACCEPTED (date): BY: (DEPUTY CLERK) American LegalNet, Inc. www.FormsWorkFlow.com Madera Superior Court Form Adopted for Optional Use TR - 300 AGREEMENT TO PAY AND FORFEIT BAIL IN INSTALLMENTS Page 2 of 2 Revised 6/04/2018 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 ask for community service (if available) instead of paying the total amount due; To request and have a court trial, to challenge the charges without deposit of bail, unless the court orders bail; 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 testifying under oath against you; and To remain silent and not testify. At any time before your final payment, if you have experienced a change in financial circumstances, you may ask that the court consider your ability to pay. If the court considers your ability to pay, the court may modify your installment plan, allow you to complete community service (if available) instead of paying the total amount due, or suspend all or part of the fine. The court is not required to offer you any or the above options, and the court may deny your request. If the court grants your request, you may no longer be eligible for traffic school. [If you do not make a payment, please contact the court as soon as possible to make arrangements.] [Optional] American LegalNet, Inc. www.FormsWorkFlow.com