The State Court of Chatham County, Georgia 133 Montgomery Street, Suite 308, Savannah, Georgia 31401 www.statecourt.org · Phone (912)652-7369 · FAX (912)652-7229 · fines@statecourt.org 1. Fill in the blanks below, where appropriate. 2. Send the form, along with the certified check or money order to: FINES COLLECTION CLERK 133 MONTGOMERY STREET, SUITE 308 SAVANNAH, GEORGIA 31401 Date Defendant's Name Case Number Sex M/F Date of Birth Home Phone Home Address Work Phone Enclosed please find certified funds (either a cashier's check or money order) In the amount of: $ Drawn on: Name of Bank or Money Order Provider Check or MO Number Check or MO Date It is recommended that you keep a copy of your completed form until the OFFICIAL RECEIPT is returned from the Clerk's Office. NOTE: This IS NOT a receipt but it can be helpful in tracing your transaction. American LegalNet, Inc. www.FormsWorkflow.com i 32-State Court Fine Payment Form 09-05