Infractions Amnesty Program Participation Form Page 2
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1
2Traffic Tickets/Infractions Amnesty Program
Participation Form – Stanislaus County Revenue Recovery
October 1, 2015 to March 31, 2017
PLEASE NOTE THE FOLLOWING:
Your participation may be cancelled if you provide incorrect information regarding victim restitution or warrants?
If, after this form is submitted, the court/county/collecting entity discovers you are not eligible for amnesty because you
have 1 or more outstanding warrants or owe victim restitution in this county, you shall be notified within 5 business
days that your form is being suspended; even if you have a minor child that owes restitution. You will then have 20
business days to bring written proof to the court/county/collecting entity that the outstanding warrant(s) and/or victim
restitution issues have been addressed. On the 21st business day, or earlier if the information you provide does not
demonstrate you are eligible for amnesty, the court/county/collecting entity will retroactively cancel the amnesty
program, restore previously reduced court‐ordered amounts, and credit any paid amounts toward your revised
outstanding debt. The court/county/collecting entity will send you notice of this action to the address indicated on this
document.
Your reduction amount may change if found that you do not qualify.
If, after this form is submitted, the court/county/collecting entity discovers you are not eligible for the 80 percent
reduction in bail/fines/fees because you are not receiving public assistance as listed or because your household income
is not at or below 125 percent of the federal poverty rate, you shall be notified within 5 business days that your amnesty
discount will be revised to 50 percent. You will then have 20 business days to bring written proof to the
court/county/collecting entity that you do receive the specified public assistance or that your income is not at or below
125 percent of the federal poverty rate for your household. On the 21st business day, or earlier if the information you
provide does not demonstrate that you are eligible for the 80 percent discount, the court/county/collecting entity will
determine whether to revise the discount, if you are eligible, to 50 percent of the amount owed for court ‐ordered debt
or impose the full amount as discussed above and credit any paid amounts toward your revised outstanding debt. The
court/county/collecting entity will send you notice of this action to the address indicated on this document.
FOR USE ONLY BY ENTITY ADMINISTERING THE AMNESTY PROGRAM
Total outstanding balance: _______________
First amnesty payment due: _____________________
Account Numbers: ________________________________________________________________________________
________________________________________________________________________________________________
The County of Stanislaus Revenue Recovery (or designated agent) has verbally verified case eligibility for the amnesty
program and has determined the following:
Eligible for:
□
□
□
50% reduction
80% reduction
Driver’s License Reinstatement
□
□
Full Payment
Payment Plan Amt ________________
Not eligible for:
□
□
□
50% reduction
80% reduction
Driver’s License Reinstatement
Reason Not Eligible:
□
□
Victim Restitution Owed
Outstanding Misd./Felony Warrant
□
Made payments for the violation after September 30, 2015
□
□
Verified with Probation:
No restitution/warrants
Date: __________________
Certified by: _________________________________________ Date:_______________________________
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