Form # 423 VERMONT JUDICIAL BUREAU 82 RAILROAD ROW PO BOX 607 WHITE RIVER JCT, VT 05001 Phone: 802-295-8869 Fax: 802-296-5539 REQUEST FOR EXTENSION OF TIME TO PAY FINE DEFENDANT Name Address Date of Birth Phone #: ( ) - COMPLAINT NUMBER I, more time to pay my fine. , Defendant request that the Court grant me I need more time to pay my fine due to the following reasons: I will have my fine paid in full by . Date (mm/dd/yyyy) SIGNATURE REQUIRED Printed name Date If you have not previously answered the complaint, please enter your plea here: No Contest SML 4/07 Or Admit Violation American LegalNet, Inc. www.FormsWorkflow.com