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2. FIFE MUNICIPAL COURT- REQUEST PAYMENT PLAN FORM
4. Case number(s)*
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Email Address*
19. STATEMENT OF DEFENDANT

    I am the defendant in the above case(s) and admit responsibility for the infraction. I understand that: 

    • I am requesting a time pay agreement.
    • I agree to pay $50/month until case(s) paid in full.
    • FAILURE TO PAY may result in my account being referred to a collection agency and I will be liable for any and all collection costs. If my case involves a traffic matter, additional penalties may be added and the Department of Licensing will be notified.
21. CASE IN COLLECTIONS

    DO NOT use this form if your case is in collections.

    Contact Linebarger Goggan Blair & Sampson, LLP at 1-844-576-4766.

23. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature*
26. Date*
    Date
28. COURT RESPONSE

    An email response will be sent with terms of your time pay agreement.

    Please contact the Fife Municipal Court at 253-922-6635, ext. 0, if you do not receive an email response within a week or need the time pay agreement mailed instead.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field