Payment Plan Application Page 2
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3** It will be your responsibility to notify our office immediately of any change in
IN WRITING
employment or address. You must also notify the Clerk of Court,
, of
any address change. **
__________________________________
______________________________________
Defendant’s Signature
Date
Sioux County Attorney
Current address:
__________________________________
Street
__________________________________
City/State/Zip
__________________________________
Phone
State of Iowa procedures to intercept any State Income Tax Refund due the defendant based upon
unpaid financial court-ordered obligations are not affected by this payment plan.
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