Application Of Extension Of Time For Payment Form Page 2
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2OBLIGATIONS (OBLIGACIONES)
LIST ALL YOUR CREDITORS (MORTGAGE COMPANIES, BANKS, CREDIT CARD ACCOUNTS, FINANCE
COMPANIES, RENT-TO-OWN COMPANIES)
ENUMERE A TODAS SUS ACREEDORES (HIPOTECA, BANCOS, TARJETAS DE CRIDITO, COMPANIAS DE FINANZA EST.)
________________________________________________________________________________________________
Company Name
Balance Owing
Payment Amount
(Nombre de la Compania)
(Balance Adeudado)
(Cantidad)
________________________________________________________________________________________________
Company Name
Balance Owing
Payment Amount
(Nombre de la Compania)
(Balance Adeudado)
(Cantidad)
________________________________________________________________________________________________
Company Name
Balance Owing
Payment Amount
(Nombre de la Compania)
(Balance Adeudado)
(Cantidad)
________________________________________________________________________________________________
Company Name
Balance Owing
Payment Amount
(Nombre de la Compania)
(Balance Adeudado)
(Cantidad)
MONTHLY EXPENSES (GASTOS MENSUALES)
Rent $______________ Utilities $______________ Phone $______________ Food $______________ Child Care $______________
(Renta)
(Utilidades)
(Telefono)
(Comida)
(Cuidado de Ninos)
Child Support $________________ Vehicle Payment $________________ Insurance $________________ Other $________________
(Mantenimiento de nino)
(Pago de Vehiculo)
(Aseguramiento)
(Otro)
LANDLORD ______________________________________________________________________________________________________
(Casero)
Name (Nombre)
Address (Direccion)
Phone (Telefono)
ACKOWLEDGEMENT AND DECLARATION
(DECLARACIONES Y JURAMENTO)
Under penalty of perjury I hereby certify the foregoing as being a complete and accurate statement of my current financial condition.
I authorize the District Clerk’s Office of Dallas County, their employees or agents to conduct a complete and thorough investigation of my
statement. I understand this investigation could include direct verifications of all information given and the obtaining of reports from credit
reporting agencies. It is with this understanding and acknowledgement that I formally request an extension of time for payment of fines, court
costs, and court appointed attorney fees if applicable.
Bajo pena de perjurio yo declaro que la siguimente es un reflejo claro de mis condiciones economicas al presente. Yo autorizo a
oficina District Clerk’s De Dallas, sus empleados o agentes a conducir una investigacion completa de esta declaracion. Yo entiendo que esta
investigacion puede incluir verificaion directa de toda la informacion proveida y obtener reportes de agencia que reportan credito. Es con este
entendimiento que yo fomalmente peticion una extencion de tiempo para pagar mis multa y costos de corte debido ahora al Condado de Dallas.
Sworn and Subscribed to this ______________ day of _______________________________ 20___________, by defendant.
(Jurado Y Suscrito Ante Mi hoy Dia)
(De)
(Por el acusado.)
___________________________________________________________________________
Defendant Signature
(Firma De Acusado)
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