Statewide Traffic Tickets/infractions Amnesty Program Butte County - Participation Form Page 2

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Butte County
Statewide Traffic Tickets/Infractions Amnesty Program
October 1, 2015 to March 31, 2017
Participation Form
B. I certify the following (attach proof):
My total gross monthly household income is $________ and a total of ____ dependents live in the
household.
The Central Collections division of the Treasurer-Tax Collector Office will provide a response regarding
amnesty eligibility within ten (10) business days.
I declare under penalty of perjury under the laws of the State of California that the foregoing statements are
true and correct to the best of my knowledge and belief. I understand that if I provide incorrect or inaccurate
information, the debt reduction amount may change and I will be responsible for payment of the re-adjusted
or full amount.
Signature__________________________________
Date ____________________
This form can be submitted: by email to
collections@buttecounty.net
or by mail/in person to:
Butte County Treasurer-Tax Collector’s Department
Central Collections Division
25 County Center Drive Suite 125
Oroville, CA 95965
530-538-7362
Please allow ten (10) business days for a response.
Rev. 9/24/2015

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