JDF 230 R 3 /1 8 NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM County Court District Court Denver Juvenile Court County, Colorado Court Address: State of Colorado v Defendant: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number Division Courtroom NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM Pursuant to 24716 - 18.5 - 107, C.R.S., as amended, the below named person (s) or entity hereby notifies the Court, the Collections Investigator, and the Department of Corrections, if D efendant was sentenced thereto, of his or her WITHDRAWAL of intent to pursue collection of restitution in his or her own name. It is further stated that: 1. The below named person is a victim in whose name a restitution order has been entered by this Court. 2. S uch order w as entered on (date of order). 3. T $ (attach Notice of Direct Payments of Restitution (JDF 242 ) with Proof of Payments). 4. T h e below named person wishes to exercise his or her right to withdraw from pursuit of collection of restitution in his or her own name pursuant to 24716 - 18.5 - 107, C.R.S., as amended. 5. T he Notice of Withdrawal of Intent to Pursue Collection by Victim was delive red to the Clerk of the Court and, if the Defendant was sentenced to the Department of Corrections, to the Executive Director of the Department of Corrections on (date delivered). 6. The below named person understands that the court wi ll resume intercepts and other collection measures in attempting to collect the restitution obligation. 7. T he below named person understands that all funds paid into the case prior to the filing of this form will remain as they were applied, whether applied to fines, fees, costs, surcharges or restitution due to another victim . 8. T he below named person is aware that the restitution balance may be subject to interest, pursuant to 24718 - 1.3 - 603(4)(b)(1),C.R.S. The court will begin to calculate and assess this i nterest, as applicable, based on the remaining amount of restitution due along with any other victims in this case. It is also understood that this interest is simple interest and that payments received will reduce the principal restitution balance until that amount is paid in full. American LegalNet, Inc. www.FormsWorkFlow.com JDF 230 R 3 /1 8 NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM 9. T he below named person understands that, in order to enable the court to assess interest for the duration of time between the filing of their Notice of Intent to Pursue Collections by Victim (JDF 229) and of this withdrawal, a completed Notice of Direct Payments of Restitution (JDF 242 ), including dates, amounts, and forms of payment, along with proof of payments, must also be filed. 10. T he below named person shall notify the collections investigator of this court of any notice that the D efendant has filed for bankruptcy within ten days of receipt of such notice. 11. U pon receipt of this Notice of Withdrawal the Collections Investigator and the Department of Corrections shall pursue collection of restitution pursuant to Article 18.5 of Title 16, C.R.S., as amended. 12. The below named person shall, within twenty - one days after the payment in full of all restitution owed, file the Notice of Direct Payments of Restitution (JDF 242 ). In addition, in the event that a transcript of the order for restitution has been recorded in the real estate records of any county in Colorado, the below named person shall obtain a Satisfaction of Judgment, issued by the Clerk of Court, and file it with each clerk and recorder where a transcript was reco rded within the same twenty - one day period. The Satisfaction of Judgment shall be conclusive evidence that any lien was extinguished . 13. T he below named person elects the following: Any restitution or interest payments applied on their behalf shall be se nt to the address listed at the end of this document (a valid mailing address must be included in this instance). Any restitution or interest payments applied on their behalf shall be held and paid to the local VALE Board as unclaimed restitution. They understand that the D efendant is still obligated to pay the court ordered restitution, but no longer wish to receive any payments. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. Signature (Printed name of Victim) Signature of Victim Date City State Zip Code (Area Code) Home Telephone Number Area Code) Work Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com