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Name: Mobile Home Phone SSN Physical Address: City State, Zip: Current Employer: Please Read & Sign Below: Initials: Signature: Date: Docket Citation PAYMENT PLAN AGREEMENT City State, Zip: Mailing Address: Terms of Payment Plan Agreement Please fill out and return to front window Woodburn Municipal Court 270 Montgomery Street Woodburn, Oregon 97071 reductions given by the Judge and/or the Violations Bureau will be revoked collection fees of up to 25%. 1. I understand that by signing below, I agree to the additional fee of $25.00 for this service to be placed on my account. 2. The $25.00 fee will be collected by the court when the final $25.00 is paid. 3. I understand that if my balance increases due to additional fines, my payment amount is subject to review & revision 4. I understand that if I do not comply with the terms of the established agreement, the Woodburn Municipal Court may take one or more of the following actions, which may result in additional fees, without further notice: ●The fine amount will return to the full presumptive fine amount and any ●SUSPENSION OF DRIVING PRIVILEGES For Court Office only: ●Referral to a collection agency, with additional assessments and/or 5. I understand that all personal information provided in this form may be used for collection purposes Note: If you elect to participate in this plan, and additional fee of $25.00 will be placed on your account. I hereby acknowledge I have read and agree to the terms set forth above. Furthermore, I certify the information I provided above is current and correct and that I will notify the Court immediately of any changes. Email: 30 day Payment Plan Type SIGN