Payment Plan Application printable pdf download

PLAN OF PAYMENT

Defendant’s Name: ________________________________

Criminal Case Nos: ________________________________

Please mark the option below that you will be using to bring case(s) current:



WAGE ASSIGNMENT. Complete Request for Wage Assignment form included in this

packet and return it with this document to the Sioux County Attorney’s Office in the envelope

provided. The wage assignment will be prepared by the County Attorney’s Office and returned

to you for signature. You MUST include a minimum payment of $50 with the Request for Wage

Assignment and Plan of Payment forms and wage assignment must be a minimum of $100 per

month from your paychecks. If you are unemployed, a wage assignment is not possible.



I AM NOT CURRENTLY EMPLOYED. Payments of no less than $50 per month will be

accepted until employed. You must return your first payment to the Clerk of Court, 210 Central

Ave SW, Orange City, IA 51041, no later than 15 days from the date of this letter, and

payments will need to continue on or before the 30

day of each month thereafter. Payments

can be cash (paid in person to Clerk of Court, 210 Central Avenue SW, Orange City), money

order, personal check, or online at

with a credit card. File numbers

must be included on all payments to ensure proper credit.



I AM CURRENTLY EMPLOYED but prefer not to enter into a Wage Assignment with

my employer. I agree to pay $_________ per month (minimum of $50 per month required

unless prior arrangements have been made with the Sioux County Attorney’s Office). I agree to

send my first payment by the _____ day of _________________, 2016, and will continue to

make monthly payments until my financial obligations are paid in full. Payments should be

made out to the Sioux County Clerk of Court and can be cash (paid in person to Clerk of

Court, 210 Central Avenue SW, Orange City), money order, personal check, or online at

with a credit card. File numbers must be included on all payments

to ensure proper credit.



PAY IN FULL. Make check or money order payable to “Clerk of Court” for the full

amount indicated above and return payment to the Clerk of Court, 210 Central Ave SW, Orange

City, IA 51041. You may also pay this amount in full with a credit card by going to



CREDIT/DEBIT CARD AUTHORIZATION. I would like my credit/debit card

automatically debited each week/month. Complete the Credit Card Authorization Form included

in this packet and return it with this document to the Sioux County Attorney’s Office in the

envelope provided.

(OVER)

Payment Plan Application