9-312A. Receipt for cash, money order, or cashier's check. [For use in the magistrate and municipal courts] STATE OF NEW MEXICO [COUNTY OF___________________] [CITY OF_____________________] IN THE __________________________ COURT [STATE OF NEW MEXICO] [COUNTY OF __________________] [CITY OF ____________________] v. ________________________________, Defendant No. __________ RECEIPT FOR CASH, MONEY ORDER, OR CASHIER'S CHECK Defendant information: Arrest date: Date of birth: Mailing address: City, state & zip code: ________________________________ ________________________________ ________________________________ ________________________________ Address (physical) (if different from mailing address): ________________________________ City, state & zip code: ________________________________ Telephone number: ________________________________ (Include current telephone number or contact information in case a refund is due.) (Fill in only if $10,000 or more is paid.) Tax ID number or Social Security number of Defendant: Occupation, profession or business: Payment information: Date of payment: Amount paid: Number of money order or cashier's check: Issuer: Payment made by: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ American LegalNet, Inc. www.FormsWorkFlow.com (print name) Mailing address of person paying cash, money order, or cashier's check if person paying is not defendant: ________________________________ City, state & zip code: ________________________________ Telephone number: ________________________________ (Include current telephone number or contact information in case a refund is due.) (Fill in only if $10,000 or more is paid.) Tax ID number or social security number of person paying: Occupation, profession or business: ________________________________ ________________________________ PERSON OTHER THAN DEFENDANT PAYING CASH, MONEY ORDER, OR CASHIER'S CHECK: I understand that the cash I have posted will be used to pay any fines, fees, or costs that the defendant owes if the court has ordered that the defendant may only be released upon the payment of such fines, fees, and costs and that if this is so I will not be entitled to a refund. If the court has not ordered that the defendant will only be released upon payment of fines, fees, and costs, [] I agree [] I do not agree that the cash I have posted may be used to pay any fines, fees, or costs that the court may order the defendant to pay after the defendant's release from custody. __________________________________ Signature of person posting cash (required) DEFENDANT: (If the defendant has been arrested on a failure to pay warrant, the defendant's signature is not required.) (This alternative may be used only when the defendant has failed to appear, the bench warrant authorizes release on payment of fines and fees, and the person posting the cash has checked the "I agree" box above.) [] I plead guilty to the charges. I ask the court to use the cash for payment of fines, fees, and costs instead of requiring me to appear before the court. (This alternative may be used only when the bench warrant authorizes release of the defendant on bond, instead of payment of fines and fees.) [] I agree to appear in the ________________ court on _______________, _____ (date) at ________ [a.m.] [p.m.]. American LegalNet, Inc. www.FormsWorkFlow.com __________________________________ Signature of defendant PAYMENT RECEIVED BY: ______________________________________ Signature of clerk or bail designee ______________________________________ Date COURT EMPLOYEE RECEIVING PAYMENT: ______________________________________ Signature ______________________________________ Date [Approved by Supreme Court Order 07-8300-34, effective January 22, 2008; as amended by Supreme Court Order No. 13-8300-037, effective for all cases pending or filed on or after December 31, 2013.] American LegalNet, Inc. www.FormsWorkFlow.com