Office of State Court Collections Office Locations: Hares Corner Main Office 97-A Parkway Circle New Castle, DE 19720 (302)323-5356 Wilmington Probation Office 1601 N. Pine St. Wilmington, DE 19801 (302)577-3443 Georgetown Probation Office 546 S. Bedford St Georgetown, DE 19947 (302)856-5243 Dover Probation Office 511 Maple Parkway Dover, DE 19901 (302)739-5387 ex.213 Sussex Violation Unit Rd 6 Box 700 Georgetown, DE 19947 (302)856-5790 ex.172 PAYMENT AGREEMENT It is hereby acknowledged by the undersigned that all fine, costs, surcharges and restitution must be paid to the OFFICE OF STATE COURT COLLECTIONS ENFORCEMENT in cash, money order or check made payable to the State of Delaware in the amounts and at the times specified by the Court, or this Payment Agreement. Personal checks must include a telephone number and current address. THERE WILL BE A $25.00 FEE FOR ALL RETURNED CHECKS. It is also acknowledged and understood that failure to abide by the specific court orders or a breach of this agreement shall be sufficient cause for a “Contempt of Court Hearing.” Court:______________________ Judge:____________________ Case#(s):_______________________________________ Defendant Name:________________________________________ SSN#________________________ Defendant Address:______________________________________ City:_______________ ______________________________________ DOB:__________ State:______ Zip:________ Home Phone:____________________________________ Employer:______________________________________________ Employer Address:_______________________________________ _______________________________________ City:_______________ State:______ Zip:________ Work Phone:_____________________________________ Payment Schedule: $____________ Per Month beginning __________________. Total/Current Balance Owed: $________________________________. **FAILURE TO COMPLY WITH THIS MONTHLY PAYMENT AGREEMENT SHALL RESULT IN A CONTEMPT OF COURT HEARING** ________________________________________ (Defendant Signature) _____________________ Date ________________________________________ (Collection Officer Signature) _____________________ Date State SBI#________________________ Driver’s License #____________________ State:___________________ White-OSCCE; Pink-Prothonotary; Yellow-Defendant Revised: 3/8/01 American LegalNet, Inc. www.FormsWorkflow.com