Application Of Extension Of Time For Payment Form

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DALLAS COUNTY DISTRICT COURTS
APPLICATION OF EXTENSION OF TIME FOR PAYMENT
HOW MANY FELONY CASES DO YOU HAVE?
(CUANTOS CASOS DE FELONIA TIENES?)
PERSONAL
NAME ____________________________________________________________________________________________________________
(Nombre)
Last (Apellido)
First (Nombre)
Middle (Segundo Nombre)
ADDRESS _________________________________________________________________________________________________________
(Direccion) Number (Numero)
Street (Calle)
City (Ciudad)
State (Estado)
Zip (Codigo Postal)
HOUSE OR APT.? ___________________
(If apt. please put apt. #) __________________________
(Casa or Apt.?)
(Apt. Numero)
PHONE (TELEFONO) _______________________________________________________________________________________________
Home (Casa)
Cell (Celular)
Work (Trabajo)
IF NO PHONE, WHERE CAN YOU BE REACHED? (Segundo Telefono) (______) ________________________
E-MAIL ADDRESS (Correo Electronico) ________________________________________________________________________________
DATE OF BIRTH _____________________
DRIVERS LICENSE # _______________
STATE ________
(Fecha De Nacimiento)
(Numer De Licencia para Manejar)
(Estado)
SOCIAL SECURITY # (Seguro Social) ______________________________ GENDER (Genero) _______ RACE (Raza) ______________
HEIGHT (Altura) ________ WEIGHT (Peso) ________ EYE COLOR (Color de ojos) ________ HAIR COLOR (Color de pelo) _________
LIST THE NAMES AND PHONE NUMBERS OF TWO (2) PERSONAL REFERENCES
(Liste el nombre y telefono de dos personas referencia)
___________________________________ (_____) ______________________ ______________________________
Name (Nombre)
Phone (Telefono)
Relationship (Pariente)
___________________________________ (_____) ______________________ ______________________________
Name (Nombre)
Phone (Telefono)
Relationship (Pariente)
ASSETS (FONDOS)
EMPLOYER __________________________________________________ (_____) ____________________ (______________________)
(Trabajo)
Name (Nombre)
Phone (Telefono)
How Long? (Anos)
_______________________________________________________________________________________________________
Address (Direccion) Number (Numero) Street (Calle)
City (Ciudad)
State (Estado) Zip (Codigo Postal)
SALARY: $ _________________
HOURLY WAGE: $ _________________
TAKE HOME MONTHLY PAY: $ _________________
(Salario)
(Salario Por Hora)
(Salario Mensual)
PLEASE CHECK ANY OTHER SOURCES OF INCOME YOU RECEIVE AND THE AMOUNT(S):
 Child Support $________/Month
 Disability $________/Month  Retirement $________/Month  Soc. Sec. $________/Month
(Mantenimiento de nino)
(Incapacidad por mes)
(Retiro por mes)
(Seg. Soc. por mes)
 Unemployment $________/Month  Welfare/Medicaid $________/Month  Other $________/Month
(Desempleo por mes)
(Otro por mes)
 Checking
BANK ACCOUNTS
at: ____________________________________________
Balance: $ ______________________
(Cuenta Bancarias)
(Cheques) (En)
 Savings
at: ____________________________________________
Balance: $______________________
(Ahorros) (En)

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