[Town of Marana] Payment Request Motion

Section 1 of 1 in this document

PAYMENT REQUEST MOTION

Defendant Name

Case No.

I am a

Defendant

Other

Other (I am a)

Payment Details

There is a payment due date

There is not an upcoming payment due date

I am in default and/or collections

Payment Date

Interpreter Needed

Yes

Language

Spanish/Español

Mandarin/國語

American Sign Language

Other

Other (Language)

I am hard of hearing (device needed)

Yes

I would like to use

Assisted Listening Device provided by the Court

Communication Access RealtimeTranslation (CART) captioner

I am filing this motion to

Set up or reduce monthly payments to

Request community restitution instead of payments

Request additional time to pay

Request to have my vehicle registration hold lifted and start making monthly payments

Other

Set Monthly Payments to

Monthly payments starting on

Other (Reason for Filing)

This motion is made for the following reason(s):

DEFENDANT’S FINANCIAL STATEMENT AND REQUEST FOR PAYMENT PLAN (LIMITED JURISDICTION)

By answering the questions below, you are telling the Court you need a payment plan. You are answering these questions under penalty of perjury and you may be held in contempt of court if you do not answer truthfully, or if you fail to notify the Court of any material improvement in your financial circumstances while your case is pending.

What is your marital status?

Single

Married

Partnered

Separated

Divorced

How many other people do you support financially?

List age and relationship to you:

Do you have a job?

Yes

If yes, what do you do and for how long?

If no, when did you last work and what did you do?

What is your approximate monthly take-home pay?

Do you have income from the following sources?

Social Security

Disability

Unemployment

Spousal or child support

Investments

Other

Not Applicable

Other (Additional income)

What is your approximate total monthly income from these sources?

What is your spouse’s approximate total monthly income from all sources?

Do you own a house?

Yes

If yes, what is the approximate value?

Approximately how much do you owe on the house?

Do you have any bank or retirement accounts?

Yes

If yes, what is the approximate total balance of the accounts?

Do you have any outstanding loans?

Yes

If yes, what type of loans:

What is the approximate balance owed?

What are your total approximate monthly expenses?

If applicable how much can you afford to pay monthly towards your balance with the court?

Any other information about your financial circumstances you want to share:

I declare under penalty of perjury that I have read the above statements and to the best of my knowledge and belief these statements are true and correct.

Today's Date

Signature

DEFENDANT INFORMATION

Defendant Name

Defendant Phone Number

Defendant Email Address

I prefer to receive correspondence by:

Mail

I am a

Payment Details

Interpreter Needed

Language

I am hard of hearing (device needed)

I would like to use

I am filing this motion to

What is your marital status?

Do you have a job?

Do you have income from the following sources?

Do you own a house?

Do you have any bank or retirement accounts?

Do you have any outstanding loans?

Defendant Address

I prefer to receive correspondence by: