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NOTICE OF PAYMENT ALTERNATIVES FOR FINES AND COSTS (City of Richmond)

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Virginia:
In the Circuit Court of the City of Richmond, John Marshall Courts Building
NOTICE OF PAYMENT ALTERNATIVES FOR FINES AND COSTS
Pursuant to
Section 19.2-354.1 and 19.2-354 (c) of the Code of Virginia
If you are unable to pay fines and costs for the offense(s) of which you were convicted within 30 days
of said conviction, the Court offers you the opportunity to enter into a deferred payment plan, a modified
deferred payment plan, or an installment plan. You may also request Court approval to perform community
service through a non-profit organization registered as a 501(c) (3) with the IRS in lieu of or to defray fines
and costs upon certain terms and conditions generally including a requirement that a minimum of 5 hours of
community service must be performed every month for a period of one year, and a credit of $10.00 per hour
for each hour of community service performed. However, community service is not available to repay
restitution, interest on restitution, and any collection fee for restitution.
Any payment received within 10 days of the due date will be considered timely made.
At any time during the duration of your payment plan, you may ask the Court to modify your plan. A
request for modification will be granted on a good faith showing of need, however you must appear in the
Clerk’s office and complete the attached form DC-211 providing your financial information.
If you have defaulted on your payment plan, you may ask the Court to approve a new payment plan.
The Court will consider any changes in your circumstances in determining whether to approve the request. A
down payment will be required if you have defaulted on a payment plan, which will be 10% of a balance of
$500.00 or less; 5% of a balance of $500.00 or more, or $50.00, whichever is greater.
You may apply for one of the below payment arrangements in the Clerk's Office of the Richmond
Circuit Court.
If you would like to request a payment plan with guidelines other than those listed below or you
would like to perform community service in lieu of fines and costs, you must complete the attached form DC-211
providing your financial information and it will be submitted to a judge. You must contact the Clerk’s Office
five
to seven days after the request is submitted to learn the Court’s decision or you risk being in default
.
The Clerk’s Office can be reached at 804-646-6553.
Please select a payment plan option:
_____DEFERRED PAYMENT PLAN:
The defendant pays all outstanding fines and costs within 6
months.
_____
INSTALLMENT PAYMENT PLAN: Unpaid fines and costs paid at a minimum rate of $50 per
month.
Defendant Name ______________________________
Date________
Address _____________________________________________________________________
Phone Number _______________________________________________________________
Virginia:
In the Circuit Court of the City of Richmond, John Marshall Courts Building
Defendant ______________________
Date_____________________
Case Nos.
___________________________________________________________________________________________________
_______
I do not have the financial resources to meet the guidelines established for the payment of
unpaid fines and costs. Therefore, I wish to enter into a Deferred Payment Plan and pay my
unpaid fines and costs in ______ months.
OR
______
I wish to enter into an installment payment plan and pay: _______ per month.
OR
______
I wish to perform community service to defray the unpaid fines and costs
and
receive a credit of $10 per hour for each hour of community service performed. A
minimum of 5 hours of community service must be performed each and every month.
Explain in your own words why you require a reduced/alternative payment plan and/or
community service (optional):
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
(Signature) (Date)
*This request will not be considered until you have completed the attached form DC-211.*
COURT USE ONLY:
APPROVED
DENIED
OTHER
Judge
______________________________________________ Date _______________
PETITION FOR PAYMENT AGREEMENT
FOR FINES AND COSTS OR
REQUEST TO MODIFY EXISTING AGREEMENT
Commonwealth of Virginia VA. CODE § 19.2-354.1
[ ] General District Court [ ] Circuit Court
.............................................................................................................................. [ ] Juvenile and Domestic Relations District Court
CITY OR COUNTY
...............................................................................................................................................................................................................................................................................
COURT ADDRESS
[ ] Commonwealth of Virginia v. ..............................................................................................................................
DEFENDANT/JUVENILE
[ ] .....................................................................................................................
.............................................................................................................................. ..............................................................................................................................
ADDRESS OF DEFENDANT/JUVENILE SOCIAL SECURITY NO.
.............................................................................................................................. ..............................................................................................................................
CITY STATE ZIP TELEPHONE NO.
I cannot pay the fines, costs, forfeiture, restitution (if not otherwise ordered), and/or penalty of $ ...................................... in full at this time.
[ ] I respectfully petition the court to allow me to pay the fines, costs, forfeiture, restitution (if not otherwise ordered) and/or
penalty plus any additional court-appointed attorney fee, if applicable,
[ ] in periodic payments OR
[ ] in one payment due in full on a future date
[ ] and I shall try to make periodic payments until that future date AND/OR
[ ] by doing community service work to earn credit for fines and costs only
, if available.
[ ] I respectfully request that the court modify my existing payment agreement for the following reasons:
.............................................................................................................................................................................................................................................................
Court Debt Owed in Other Courts:
[ ] I currently owe unpaid fines, costs, forfeiture, restitution, and/or penalty in ............................. other courts.
NO.
[ ] I owe a total of $ ....................................................... in those other courts. [ ] I do not know the total of unpaid court debt owed.
TOTAL OWED
[ ] I pay a total of $ ........................................................ per month towards that unpaid court debt. [ ] DMV summary attached.
[ ] I do not have unpaid court debt in other courts.
Financial Information:
[ ] The information provided to this court by defendant on Form DC-333, FINANCIAL STATEMENT – ELIGIBILITY DETERMINATION
FOR
INDIGENT DEFENSE SERVICES, as previously submitted, is unchanged.
OR
[ ] This information is provided to this court below in support of this Petition or Request:
Public Assistance:
[ ] I currently receive the following type(s) of public assistance:
[ ] TANF $
...................................................... [ ] Medicaid [ ] Supplemental Security Income $ ..................................................
[ ] SNAP (food stamps) $ .................................................... [ ] Other (specify type and amount) .....................................................................
[ ] I do not receive public assistance.
Employment:
[ ] I am employed.
[ ] I am not currently employed and it has been
........................... months since I was last employed.
Employer(s) Occupation
Defendant ................................................................................................................ [ ] self-employed ..........................................................................................
Spouse ...................................................................................................................... [ ] self-employed ..........................................................................................
Number of Dependents ..........................................
Defendant Spouse
Household Net Income:
Take-Home Pay (after taxes, etc.) $
................................ $ ...............................
Pay Period (weekly, every 2 weeks, $ ................................ $ ...............................
twice monthly, monthly)
Other Income Sources (specify)
...................................................................... $ ................................ $ ...............................
Income Contribution of Dependents $ ................................ $ ...............................
TOTAL NET INCOME = $ ................................
Case No(s).
..........................................................................................
..........................................................................................
..........................................................................................
FORM DC-211 (MASTER, PAGE ONE OF TWO) 07/17
Clear All Data
Case No. ........................................................................................
Defendant Spouse
Assets:
Bank Accounts/Cash on Hand $
................................ $ ...............................
Other Assets (specify)
with a
.......................................................................................... value of .............................
$ ................................ $ ...............................
Real Estate – $ .................................................................... $ ................................ $ ...............................
NET VALUE
..................................................... ..........................................................
YEAR AND MAKE YEAR AND MAKE
Other Personal Property: (describe) .............................................................. $ ................................ $ ...............................
.......................................................................................................................................
TOTAL ASSETS = $ ................................
Debts Owed (amount paid per month):
Car payment $
................................ $ ...............................
Rent/mortgage payment $ ................................ $ ...............................
Credit card payments $ ................................ $ ...............................
Other monthly payments (not including court debt payments) $ ................................ $ ...............................
TOTAL MONTHLY DEBTS = $ ................................
EXCEPTIONAL EXPENSES (Total Exceptional Expenses of Family)
Medical Expenses (list only unusual and continuing expenses)
.................................................................. $ .............................
Court-ordered child support payments/alimony ................................................................................................. $ .............................
[ ] deducted from paycheck [ ] not deducted from paycheck
Child-care payments (e.g. day care)
........................................................................................................................ $ .............................
Other (describe):
...........
............................................................................................................................................................. $ ................. .
TOTAL EXCEPTIONAL EXPENSES $ ..............................
THIS STATEMENT IS MADE UNDER OATH, ANY FALSE STATEMENT OF A MATERIAL FACT TO ANY QUESTIONS
CONTAINED HEREIN SHALL CONSTITUTE PERJURY UNDER THE PROVISIONS OF VA. CODE § 18.2-434. THE
MAXIMUM PENALTY FOR PERJURY IS CONFINEMENT IN THE STATE PENITENTIARY FOR A PERIOD OF TEN YEARS.
I hereby state that the above information is correct to the best of my knowledge.
....................................................................... _____________________________________________________________
DATE DEFENDANT
Sworn to and signed before me this
.....................
day of ............................................................... , 20 ........... _____________________________________________________________
[ ] CLERK [ ] DEPUTY CLERK
ORDER FOR REQUEST TO MODIFY
EXISTING PAYMENT AGREEMENT
Upon request to modify an existing payment agreement,
[ ] the request is granted based upon a good faith showing of need, and the new payment agreement is set forth on form
[ ] DC-210, A
CKNOWLEDGMENT OF SUSPENSION OR REVOCATION OF DRIVER’S LICENSE
[ ] CC-1379, A
CKNOWLEDGMENT OF SUSPENSION OR REVOCATION OF DRIVER’S LICENSE/ORDER AND NOTICE OF DEFERRED
PAYMENT OR INSTALLMENT PAYMENTS.
[ ] the request is denied, and the current payment agreement continues in full force and effect.
.......................................................................................... _________________________________________________________
DATE [ ] JUDGE [ ] CLERK [ ] DEPUTY CLERK
Motor
Vehicles
FOR NOTARY PUBLIC’S USE ONLY:
State of ............................................................................................ [ ] City [ ] County of ..............................................................................................
Acknowledged, subscribed and sworn to before me this ...................... day of ........................................................................... , 20 ................ .
................................................................................................ _____________________________________________________
NOTARY REGISTRATION NUMBER NOTARY PUBLIC
(My commission expires: ................................................... )
FORM DC-211 (MASTER, PAGE TWO OF TWO) 07/17
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NOTICE OF PAYMENT ALTERNATIVES FOR FINES AND COSTS (City of Richmond)

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Completed 24 January 2021

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