Application For Payment Of Court Costs, Fines And Fees Form

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COMAL COUNTY COURT AT LAW COMPLIANCE AND COLLECTIONS UNIT
APPLICATION FOR PAYMENT OF COURT COSTS, FINES AND FEES
CAUSE NO: _________________________
ANSWER ALL QUESTION IF NOT APPLICABLE, PLACE (N/A)
Name: _____________________________________________________________________________________________________
(Nombre)
Last (Apelido)
First (Nombre)
Middle (Segundo Nombre)
Street Address: _______________________________________________________________________________________________
(
Direcion)
Number
Street
Apt.
City
State
Zip
(Numero)
(Casse)
(Ciudad)
(Estado)
(Codigo Postal)
Mailing Address: _____________________________________________________________________________________________
(Direcion De Envio) Number
Street
Apt.
City
State
Zip
(Numero)
(Casse)
(Ciudad)
(Estado)
(Codigo Postal)
Home PhoneNumber: (
)_________________ If no phone, give a number where you can be reached (
) __________________
(Telephono)
(Secundo Telefono)
Cell Phone Number: (
) _______________ Social Security Number: ________-________-________
(Cellular)
(Numero de Seguridad Social)
Sex: _________ Date of Birth: ____________________ Drivers License No.: ____________________________ State: ___________
(Sexo)
(Fecha de Nacimiento)
(Numero de Icencia Para Manejar)
Single ______ Married ______ Seperated _____ Divorced _____ Education Level Completed______
(Solitero)
(Casado)
(Separado)
(Divorciado)
(Grado de Educacion)
________
Fiend (
) ________________________________________________________________________________________
(Amigo)
Phone No. (Telefono)
Relationship (Relacio)
Name (Nombre)
______________
Friend (
) _______________________________________________________________________________
(Amigo)
Phone No. (Telefono)
Relationship (Relacio)
Name (Nombre)
ASSETS: If you are not working, state why. If you are in school, state which school.
Employer: _________________________________________________ (
) ___________________________________________
(Empleador)
Name
Address
Phone No.
Position
How Long
(Nombre)
(Direcion)
(Telefono)
(Puesto)
(La Duration)
Salary: ____________________ Hourly Wage $ _____________________ Take Home Monthly Pay $ ______________________
(Salario)
(Salario por Hora)
(Salario Mensual)
How often are you paid? Weekly ______ Bi-weekly ______ Monthly ______
What day do you get paid? _________________
PLEASE CHECK ANY OTHER SOURCE OF INCOME YOU RECEIVE: (Indique otro tipo de sueldo)
Welfare ______ Social Security ______ Retirement ______ Unemployment ______ Child Support ______ Disability ______
(Assistencia de Social)
(Retiro )
(Desempleo)
(Sestenimiento de Ninos)
(Incapcidad)
Other than yourself, how many people do you support directly: __________ _____________________________ _________________
( Cuantas Personas Mantienes)
Number
Relationship
Ages
(Numero)
(Relacion)
(Edad)
Creditors: (Mortgage Companies, Banks, Credit Cards, Finance Companies, Department Stores, ect.)
(De Creditos y Deudad)
_______________________________________________________________ $__________________________________ $__________________________________
Company Name (Nombre de Compania)
Balance owed (De Pagos)
Monthly payment (Pago Mensual)
_______________________________________________________________ $__________________________________ $__________________________________
Company Name (Nombre de Compania)
Balance owed (De Pagos)
Monthly payment (Pago Mensual)
Last Revised 9/17/08

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