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Clerk of the Circuit Court & Comptroller
Office of Gary J. Cooney, Clerk & Comptroller
P O. Box 7800 # 550 W. Main St. # Tavares, FL 32778-7800 # www LakeCountyClerk, org
PAYMENT PLAN APPLICATION AND AGREEMENT
Payment Plan Applications will be reviewed by Clerk staff. Applicable payment terms will be corfipleted and
returned to the applicant for final agreement. For questions related to payment plans, call (352) Al 16-or
prt
email paymentplans@:lakecountyclerk.org.
DEFENDANT INFORMATION:
First Name Si eveDy Middle Name: Cotuuntich Last Name: (Ao Wwe’?
Case Number (only one case per application): 35-2021-MM-004836-AXXX-XX
Street Address “Iso ( Nena \ S
City: My \alwe State: el Or iar zip SASS
Date of Birth: 30/89 Driver License No CsOAl G-73 3-89 25°00
Cell Phone: 399-BAQK = IANA Home Phone CL
Email oliver Stew Qwmadcd .com
° If submitting this application by email, I consent to receive information by email regarding this plan.
C1 Yes 10
If text messaging payment reminder notifications become available in the future, I consent to receive
said notifications and understand that standard message and data rates may apply. Yes [[] No
. I wish to update my address information to that listed in this agreement. [_] Yes No
PAYMENT PLAN TERMS & CONDITIONS:
XO)SS OW) OASGi 0) 2 (Ol Dm Oy Dm On Ba
The above-named defendant will pay fees, service charges, and costs, in the total amount of $, 543.50
with one initial payment of $ no later than, Le followed by 1A, equal
payments in the amount of $ OO per month beginnin al- , and continuing on the
day of each month until paid in full
e I understand and agree that I am subject to pay a $25 administrative fee to establish a payment plan
° I agree to make monthly payments as outlined above until the total amount of court costs, service
charges, and other fees are paid in full. Upon returning a signed copy of this agreement, a detailed
payment schedule with my monthly payment amount and due dates will be returned to the email address
provided in this application >
BS
Payment Plan Agreement | Page 2
I agree to update my contact information with the Clerk & Comptroller’s Office in writing by email to
paymentplans@lakecountyclerk.ory or by mail to Lake County Clerk of Courts, Attn: Payment Plans,
P.O. Box 7800, Tavares, FL 32778.
. Criminal cases may be subject to a non-refundable lien fee of $22.00.
¢ understand that these monthly payments will be applied first towards any fine amounts owed.
FAILURE TO COMPLY:
Failure to make timely payments pursuant to the terms of this payment plan may result in the assessment
of late fees and driver license suspension pursuant to Sections 318.15 and 322.245, Florida Statutes.
Any three missed payments may result in this case being referred to a collection agency, and additional
fees of up to 40% will be assessed pursuant to Section 28.246(6), Florida Statutes.
A failure to pay timely, which results in any criminal fine assessed by the court not being paid by the
date established by the court, may result in the arrest of the defendant for failure to pay the fine.
ACKNOWLEDGEMENT OF TERMS:
Under penalty of perjury, I declare that I have read this payment plan agreement and that the facts stated in it
are true. I understand the above terms and conditions of my financial obligations, and agree to comply with this
payment plan.
k
Shewea
ited Wame
Udrowwec
Signature
lo/ar/a qT
Dated
WAYS TO PAY:
Pay Online: Visit https://www.lakecountyclerk.org/clerkpay to pay online. The financial service provider
charges a nominal, non-refundable fee for each credit card or electronic check transaction paid online.
Pay by Phone (For Traffic and Criminal Cases Only): Call (352) 742-3846 from 8:30 a.m. to 5 p.m.,
Monday through Friday, to pay by credit card over the phone. The financial service provider charges a
nominal, non-refundable fee for each credit card transaction. The name on the credit or debit card must
match the name on the court case.
Pay by Mail: Mail a cashier’s check or money order, and include your case number with your payment.
Mail to Gary J. Cooney, Clerk of the Circuit Court and Comptroller, Attn: Traffic Department, P.O. Box
7800, Tavares, FL 32778-7800.
Pay In-Person: Pay in person by cash, cashier’s check, money order, or credit card at the Lake County
Courthouse, East Wing, First Floor, 550 W. Main St., Tavares, FL 32778.
Pay by Drop-Box: Next-business-day payments (please include your case number) by cashier’s check
or money order (no cash) may be made using one of our drop-boxes available at the following locations:
o Clermont: 290 Citrus Tower Blvd., Suite 116, Clermont
o Downtown Tavares (Veterans Services Building): 418 W. Alfred Street, Tavares
o Leesburg: 1720 N. Citrus Blvd, Leesburg
Preview
Clerk of the Circuit Court & Comptroller Office of Gary J. Cooney, Clerk & Comptroller P O. Box 7800 # 550 W. Main St. # Tavares, FL 32778-7800 # www LakeCountyClerk, org PAYMENT PLAN APPLICATION AND AGREEMENT Payment Plan Applications will be reviewed by Clerk staff. Applicable payment terms will be corfipleted and returned to the applicant for final agreement. For questions related to payment plans, call (352) Al 16-or prt email paymentplans@:lakecountyclerk.org. DEFENDANT INFORMATION: First Name Si eveDy Middle Name: Cotuuntich Last Name: (Ao Wwe’? Case Number (only one case per application): 35-2021-MM-004836-AXXX-XX Street Address “Iso ( Nena \ S City: My \alwe State: el Or iar zip SASS Date of Birth: 30/89 Driver License No CsOAl G-73 3-89 25°00 Cell Phone: 399-BAQK = IANA Home Phone CL Email oliver Stew Qwmadcd .com ° If submitting this application by email, I consent to receive information by email regarding this plan. C1 Yes 10 If text messaging payment reminder notifications become available in the future, I consent to receive said notifications and understand that standard message and data rates may apply. Yes [[] No . I wish to update my address information to that listed in this agreement. [_] Yes No PAYMENT PLAN TERMS & CONDITIONS: XO)SS OW) OASGi 0) 2 (Ol Dm Oy Dm On Ba The above-named defendant will pay fees, service charges, and costs, in the total amount of $, 543.50 with one initial payment of $ no later than, Le followed by 1A, equal payments in the amount of $ OO per month beginnin al- , and continuing on the day of each month until paid in full e I understand and agree that I am subject to pay a $25 administrative fee to establish a payment plan ° I agree to make monthly payments as outlined above until the total amount of court costs, service charges, and other fees are paid in full. Upon returning a signed copy of this agreement, a detailed payment schedule with my monthly payment amount and due dates will be returned to the email address provided in this application > BS Payment Plan Agreement | Page 2 I agree to update my contact information with the Clerk & Comptroller’s Office in writing by email to paymentplans@lakecountyclerk.ory or by mail to Lake County Clerk of Courts, Attn: Payment Plans, P.O. Box 7800, Tavares, FL 32778. . Criminal cases may be subject to a non-refundable lien fee of $22.00. ¢ understand that these monthly payments will be applied first towards any fine amounts owed. FAILURE TO COMPLY: Failure to make timely payments pursuant to the terms of this payment plan may result in the assessment of late fees and driver license suspension pursuant to Sections 318.15 and 322.245, Florida Statutes. Any three missed payments may result in this case being referred to a collection agency, and additional fees of up to 40% will be assessed pursuant to Section 28.246(6), Florida Statutes. A failure to pay timely, which results in any criminal fine assessed by the court not being paid by the date established by the court, may result in the arrest of the defendant for failure to pay the fine. ACKNOWLEDGEMENT OF TERMS: Under penalty of perjury, I declare that I have read this payment plan agreement and that the facts stated in it are true. I understand the above terms and conditions of my financial obligations, and agree to comply with this payment plan. k Shewea ited Wame Udrowwec Signature lo/ar/a qT Dated WAYS TO PAY: Pay Online: Visit https://www.lakecountyclerk.org/clerkpay to pay online. The financial service provider charges a nominal, non-refundable fee for each credit card or electronic check transaction paid online. Pay by Phone (For Traffic and Criminal Cases Only): Call (352) 742-3846 from 8:30 a.m. to 5 p.m., Monday through Friday, to pay by credit card over the phone. The financial service provider charges a nominal, non-refundable fee for each credit card transaction. The name on the credit or debit card must match the name on the court case. Pay by Mail: Mail a cashier’s check or money order, and include your case number with your payment. Mail to Gary J. Cooney, Clerk of the Circuit Court and Comptroller, Attn: Traffic Department, P.O. Box 7800, Tavares, FL 32778-7800. Pay In-Person: Pay in person by cash, cashier’s check, money order, or credit card at the Lake County Courthouse, East Wing, First Floor, 550 W. Main St., Tavares, FL 32778. Pay by Drop-Box: Next-business-day payments (please include your case number) by cashier’s check or money order (no cash) may be made using one of our drop-boxes available at the following locations: o Clermont: 290 Citrus Tower Blvd., Suite 116, Clermont o Downtown Tavares (Veterans Services Building): 418 W. Alfred Street, Tavares o Leesburg: 1720 N. Citrus Blvd, Leesburg