Corona Payment Processing Center, 505 S Buena Vista, Corona, CA 92882 Indio Superior Court, 46-200 Oasis Street, Indio, CA 92201 FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: PAYMENT INSTALLMENT AGREEMENT CITATION NUMBER: TO BE FILLED OUT BY A COURT CLERK Read carefully and, if you agree, sign and return the form to the clerk. CASE NUMBER: 1. I am the defendant in this case and I have been charged with the following infraction violation that does not require me to go into court: a. § b. § c. § d. § 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 listed above, but I am not able to and I ask the court to allow me to pay in installments. I understand the court has costs and expenses from accepting a request to pay and forfeit bail in installments and 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 administrative fee of $35.00 to pay in installments) is $ $50.00 each month starting (date): $ .00 each month starting (date): and by the and by the . day of each month until paid in full. day of each month until paid in full. 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 payment by each due date, I will see the clerk on the next court date 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. If proof of correction has been filed with the clerk as required, and all amounts due are paid in full, the 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 page 2, which I now choose to give up, and that I have read, understand, and accept the terms and consequences stated above. (SIGNATURE OF DEFENDANT) (DATE) (TYPE OR PRINT NAME) (ADDRESS) (DRIVER’S LICENSE/ID NUMBER) (TELEPHONE NUMBER) (CITY, STATE, AND ZIP CODE) CLERK OF THE SUPERIOR COURT ACCEPTED: (date) BY: (DEPUTY CLERK) Form # RI-OTS39 (Revised 07/08/09) PAYMENT INSTALLMENT AGREEMENT (Traffic Infractions) Page 1 of 2 RI-OTS39 RI-OTS39 American LegalNet, Inc. www.FormsWorkFlow.com Defendant: Case No: 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 for formal arraignment, plea, and sentencing; To have a court trial 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. Form # RI-OTS39 (Revised 07/08/09) PAYMENT INSTALLMENT AGREEMENT (Traffic Infractions) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT – STATE OF CALIFORNIA COUNTY OF RIVERSIDE Payment Installment Plan Instruction Sheet A payment installment agreement is required if you elect to make payments in cases involving infraction violations with the exception of those violations requiring a mandatory appearance. The following instructions tell you how to proceed: Read pages 1 and 2 of the Payment Installment Agreement Form. IMPORTANT: Page 2 of the Payment Agreement Form contains your rights. 2. Completely fill out the form (Heading and items 1 – 5) as follows: 1. Court Address Check the box next to the court name and address that is listed at the bottom of your citation. Case Information 3. Complete the upper portion of the form: a. Your Name b. Citation Number (Preprinted Number on the upper right hand corner and/or lower right hand corner of your citation. Please make sure to include both the number and letters, if any). 4. Complete Items 1 & 5 List the infraction violations on your citation. For example: If you were cited for: VC 22349B – Exceeding the maximum speed and VC 21658A – Unsafe Lane Change, write in the violations as follows: a. § VC22349B b. § VC21658A Insert the total amount due, start date and due date as directed by the court. 5. Sign, date and print your name, address and Drivers/ID Number at the bottom of the form. 6. Mail and/or hand deliver the form to any Riverside County Court location. NOTE: Failure to deliver the form to the court on or before the due date may result in a civil assessment of $300.00 under Penal Code section 1214.1, a vehicle license hold, or wage garnishment. 1 American LegalNet, Inc. www.FormsWorkFlow.com