500-00423 226 Request for Extension of Time to Pay (03/2019) Page 1 of 1 Vermont Judicial Bureau PO Box 607 White River Junction, VT 05001 Phone: 802 - 295 - 8869 www.vermontjudiciary.org JUD.VJB@vermont.gov Request for Extension of Time to Pay DEFENDANT INFORMATION Name: Mailing Address Street: City: State: Zip: Date of Birth: Phone: Email Address: COMPLAINT NUMBERS REQUEST I request more time to pay the Judgments for the Complaints listed above. I have enclosed a check/money order for a partial payment of $. Minimum Partial Payments: $30 for each Complaint for up to 3 Complaints as listed above $100 for all Complaints for 4 or more Complaints as listed above Date: Signature Required Printed Name American LegalNet, Inc. www.FormsWorkFlow.com