Municipal Court Payment Agreement * == requiredI, Fill In Your Name:* First Last have been sentenced in the Municipal Court for the City of Hood River, to pay fines totaling: Enter Your Fine Here*Case #(s):* The Court has granted my request to pay fines on a monthly basis & I agree to the following: Keep the Court informed of my current mailing/physical address, until all fines are paid. Accept all Orders of this Court sent by U.S. Mail related to the payment of my fines, including further Orders to Appear for Show Cause Hearings per ORS 161.685. To pay all fines and fees owed to this Court, totaling: Total Amount of Your Fine with Fee Added:Based on the total amount of your fine, the required monthly payments are listed below: If your total fine is less than $250, you'll pay $50 per month If your total fine is between $251 and $500, you'll pay $75 per month If your total fine is more than $500, you'll pay $100 per month Please check this box below if you have another monthly payment arrangement set by Judge Other payment arrangement set by Judge Other Arrangement Monthly Amount:*Other arrangement Details*Your Monthly Payment I agree to pay monthly installments in the amount of:Monthly Installment Amounts*beginning on the 15th ofMonth of First Payment*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear of First Payment*202020212022202320242025I agree to pay the installment every month until all fines are paid in full.I have thoroughly read and understand this document to which I freely and voluntarily enter into this agreement with the City of Hood River Municipal Court. I understand that the Court does not send payment reminders/invoices and that I must pay monthly installments as agreed. Payments can be made online at www.cityofhoodriver.com/court. Credit cards are subject to a 3% fee. Failure to pay fines as agreed may result in your balance forwarded to a collection agencyAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneSocial Security Number/Individual Taxpayer Identification Number:*Signature* First Last Date* MM slash DD slash YYYY Signature Acknowledgement* By checking this box and typing my name above it, I am electronically signing this document.