PAYMENT FORM Complete this form when making a payment in order to satisfy your citation(s). • Mail the yellow citation or a copy with this form to: CLERK OF COUNTY COURTS, TRAFFIC COURTS DIVISION P.O. BOX 19321 MIAMI, FL 33101-9321 • You may pay by check or money order. Please make check or money order payable to CLERK OF COURTS. Do not send cash. • To avoid late fees and the suspension of your driver’s license your payment must be received in this office WITHIN 30 DAYS of the issue date of the citation. PLEASE PRINT LAST NAME FIRST NAME MIDDLE NAME STREET ADDRESS CITY ( APT. # STATE ZIP CODE ) AREA CODE TELEPHONE NUMBER CITATION NUMBER _______________________ _______________________ _______________________ _______________________ $ TOTAL $ CLK/CT 900 REV. 10/10 AMOUNT PAID ___________________ ___________________ ___________________ ___________________ ___________________ Clerk's web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com