Fillable PAYMENT PLAN APPLICATION (Pottawattamie County, Iowa)

Fill Online, Printable, Fillable, Blank PAYMENT PLAN APPLICATION (Pottawattamie County, Iowa) Form

Use Fill to complete blank online POTTAWATTAMIE COUNTY, IOWA (IA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PAYMENT PLAN APPLICATION (Pottawattamie County, Iowa)

On average this form takes 15 minutes to complete

The PAYMENT PLAN APPLICATION (Pottawattamie County, Iowa) form is 5 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 60 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Pottawattamie County, Iowa

BROWSE POTTAWATTAMIE COUNTY, IOWA (IA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
PAYMENT PLAN APPLICATION
INSTRUCTIONS AND INFORMATION
1. You personally must have income (other than child support or state aid for families) to qualify for a
payment plan.
2. Complete the following pages:
• Financial Affidavit
• Questionnaire regarding driver’s license and your right to register an automobile
• Voluntary Wage Assignment
3. If your driver’s license is suspended, we will check with the Driver’s License Bureau to see what is
holding your license and if you owe any civil penalties that we may wrap into the payment plan.
4. The County Attorney’ Office will prepare the Payment Plan and mail a letter to your home when your
plan is ready to be signed. You will need to bring the following to the Pottawattamie County Attorney’s
Office:
• First Month’s Payment - MUST BE BY CHECK OR MONEY ORDER
• Proof of automobile insurance if applying for license reinstatement
If you want a driver’s license, you are required to have and keep car insurance while on the payment
plan. If you do not own a car, you must have non-owner’s insurance.
5. If you’re making direct payments, pay in cash at the Clerk of Court, or mail a check or money order
to:
County Attorney’s Office
P. O. Box 0127
Council Bluffs, IA 51502-0127
MAKE YOUR CHECK OR MONEY ORDER PAYABLE TO: CLERK OF COURT (Print your name on the
check or money order.)
Pay online https://www.iowacourts.state.ia.us/ESAWebApp/EPayment/EPaymentSearchFrame.jsp
6. If you have a job, you must sign the Voluntary Wage Assignment. You are responsible for paying the
fines! If deductions are not coming out of your paycheck within two pay periods after you set up your
wage assignment, or if your deduction stops for any reason, you must contact your payroll office to see
why. You must also notify the County Attorney’s office by calling Rhonda at 712-328-5649 or emailing
rhonda.blair@pottcounty-ia.gov.
7. About fourteen days after you sign the plan(s), you should be able to get your license.
The County Attorney’s office does NOT accept cash. You are REQUIRED to tell the Clerk that you are
making a payment on a County Attorney Payment Plan to make certain the payment will be credited toward
your plan.
If you have any questions, call the County Attorney’s Office at 712-328-5649. Please note the more calls we
have to deal with the longer it takes to get the plans out.
RETURN FORM VIA EMAIL TO:
paymentplan@pottcounty-ia.gov
Rhonda.blair@pottcounty-ia.gov
POTTAWATTAMIE COUNTY ATTORNEY’S OFFICE
PAYMENT PLAN ASSISTANCE & LICENSE REINSTATEMENT
FINANCIAL AFFIDAVIT
Name (Print Clearly): SSN#
_Address: ____________ __________________________________
Street City State Zip
)
Phone: (
_ (
_____ ____)
_________________________________(____)_______________________________
Home
Work
Cell
Email Address:____________________________________
 How many hours per week do you work?NoDo you have a job? Yes ___ _______________ __________________
What is your job title/job duties?
_
Employers Name(Who pays your wages):
Employer Address: ( )_______________
Street City State Zip Phone
How long have you worked at present job?
How much do you earn monthly (Gross)?
List any other source(s) of income: Amount:
 If so, who?NoDoes anyone help pay monthly expenses? Yes______ _______ ______________________________
Number of Dependants: Do you pay child support? How much?
 What is your monthly payment? OwnDo you rent or own property? Rent_____ __ ____ ___________________________
 Name of bank: NoDo you have bank accounts? Yes____ _____ _________________________________________
Do you have a vehicle? (Make/Model/YR)
Total Amount of monthly expenses:
 Total fines owed: NoDo you have any pending criminal charges/traffic tickets? Yes____ ___ __ _______________________
Probation Officer is(supervised or un supervised):
NoHave you been on a payment in the past? Yes____ ____
I SWEAR UNDER PENALTY OF PERJURY THAT THE INFORMATION ON THIS FINANCIAL AFFIDAVIT IS
TRUE AND CORRECT.
Date: Signature:
DOB: Driver’s License Number:
QUESTIONAIRE:
I
am applying to have my driver’s license back.
NOTE: This will require you to have automobile insurance and keep it
throughout the term of your payment agreement. Dropping your insurance will
be a reason for having your license re-suspended. If you don’t have a vehicle, you
must have a non-owner’s policy (contact a local insurance agent for details).
I am applying to be able to license a motor vehicle.
I am applying to meet the requirement for release from probation.
PAYMENT PLAN OPTIONS
SELECT ONE OF THE FOLLOWING PAYMENT OPTIONS:
1. ASSIGNMENT OF WAGES: at $ per month
(MINIMUM MONTHLY PAYMENT is $120.00). Please review your pay stubs. If you do not see
deductions coming out of your paycheck within two pay periods after you set up your wage assignment,
or if your deduction stops for any reason, you must contact your payroll office to see why.
You must also notify the County Attorney’s office by calling Rhonda at 328-5649 or emailing
rhonda.blair@pottcounty-ia.gov
2. DIRECT PAYMENT at $ per month
(MINIMUM MONTHLY PAYMENT is $120.00) Applies only if you are self-employed- You will
be required to provide your last year tax returns and 1099’s. Unemployed or Worker’s Compensation you
will be required to provide proof of this):
Payments are due by the last day of the month and payable to the Clerk of Court. You can
pay in the following ways:
1. Cash only in person;
2. Money Order;
3. Card;
or
4. Check
5. Online at https://www.iowacourts.state.ia.us/ESAWebApp/EPayment/EPaymentSearchFrame.jsp
3. DIRECT PAYMENT at $ per month
(MINIMUM MONTHLY PAYMENT is $60.00) Applies only if you are disabled or retired. You
will be required to provide proof of this
Payments are due by the last day of the month and payable to the Clerk of Court. You can
pay in the following ways:
1. Cash only in person;
2. Money Order;
3. Card; or
4. Check
5. Pay online https://www.iowacourts.state.ia.us/ESAWebApp/EPayment/EPaymentSearchFrame.jsp
However, your first payment must be made at the Pottawattamie County Attorney’s
Office with a money order or check.
Any changes in empl
oyment or problems paying you should contact Rhonda Richardson Blair at
712-328-5649 or Rhonda.blair@pottcounty-ia.gov
VOLUNTARY WAGE ASSIGNMENT
Name:
Address:
Street City State Zip
Phone: (___)
EMPLOYMENT INFORMATION
Employer:
Address:
Street City State Zip
Phone: (___)
WAGE INFORMATION
per month to the Clerk of Court. My employer
may deduct equal amounts from each paycheck I receive in a month, as long as the total
deducted per month equals the above stated amount.
I am assigning wages at the rate of $________
The minimum deduction for wage assignments is $120.00 monthly
. Any
other arrangements must be approved by the County Attorney’s office. NO wage
assignment will be written for less than One Hundred Twenty Dollars ($120) monthly.
Signature Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PAYMENT PLAN APPLICATION (Pottawattamie County, Iowa)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document