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iELON |
LSS FOI
13/f en eA Kelvin Soto, Esq.
. z neh Poe 2] Clerk of the Circuit Court & Comptroller
We
1
NSS Tone
Osceola County
Payment Pian Application & Agreement 3
. ACKNOWLEDGEMENT OF TERMS AND FAILURE TO COMPLY CONSEQUENCES
Section 1 (s. 28.246(4), F.S.)
Initial | attest/confirm/swear that the information provided on this application is true and accurate
to the best of my knowledge. ! will abide by the terms of the payment plan and understand
ME,
A ete failure to obligation
financial do so mayandresultpotentially
in the suspension
my case(s)ofbeing
additional collection fees assessed.
my driver’s
referredlicense forfailureagency
to a collection to pay and
a
| understand that court-imposed financial obligations are penalties from my sentence and
LEY. pursuant to F.S. 938.30, ! am required to pay for all fines, fees, and costs incurred from
rudd my case proceeding(s).
| wish to enroll in a payment plan per s. 28.246(4)(B), F.S.
| Applicant Signature il _. Date
A atA ! ple: aed
. GENERAL INFORMATION
Section 2 (s. 28.246(4}(b), F.S.)
First Name Middle Name Last Name
JESUS ALBERTO GONZALEZ RIVERA
Street Address
2400 ASHECROFT DR
City State Zip Code
KISSIMMEE FL 34744
Date of Birth Driver License or State ID Number
12/24/1986 G524421864640
PAYMENT NOTIFICATIONS
Data and message rates may apply.
| consent to payment notifications by email Email Address
1 Yes OUNo
Tconsent to automated notifications by phone] ! consent to payment notifications by text message
O Yes ONo Ol Yes OINo
Phone Number Cell Phone
RECEIVED °
OAT 42 alee
|
Clerk of Court
CCOAA Printed: 10/12/2022 3:00:55PM ApplicantInitials , ek
Page iof4 ~"
Pe -
ELT Co Y
TEXa) Kelvin Soto, Esq.
i oe !| Clerkofthe
henwea CircuitCourt& Comptroller
Osceola County |
_. Sai:
Payment Plan Application & Agreement
Section 3 FINANCIAL INFORMATION |
How much can you afford to pay per month? $ a O).
| How much can you afford to pay as a down payment? $ SS"
My net income pay is $ 49,0. (select only one):
a weekly 0 bi-weekly Oo monthly O sem+monthly O yearly
Total net annual income pay consists of total salary and wages, minus deductions required by law,
including court-ordered support payments. - s. 27.52(1), F.S.
|
1. Social Security benefits $ Web D weekly o bi-weekly o monthly a semimonthly o yearly
| My Income sources are:
94.3.. Unemploymentcompensation$
Reemployment Assistance $
Union funds $ bh
isec.
ry, i 0 weeklyg
weekly O bi-weekly
bi-weekly oO monthly
monthly oo semimonthly9
semimonthly O yearly
yearly
o weekly m bi-weekly o monthly o semi+monthly a yearly
- 5. Retirement/pensions $ wt T- O weekly o bi-weekly | monthly sem-monthly o yearly ,
| 6. Trusts or gifts $ \ ifreal 0 weekly o bi-weekly o monthly o semimonthly a yearly
| 7. Veterans’ benefit $ Pe D weekly o bi-weekly o monthly a semi#-monthly o yearly. }
. 8. Worker's compensation $ ene O weekly o bi-weekly a monthly o semimonthly a yearly
9. Rental income $ WYLe oO weekly o bi-weekly o monthly o semi-monthly o yearly
| 10. Dividends or interest $ iN, Le o weekly o bi-weekly o monthly o semimonthly O yearly
| 141. Support from family members $ nb LAX... o weekly o bi-weekly o monthly o sem-monthly o yearly
412. Other income not on the list $. f Ve . o weekly o bi-weekly o monthly o semi-monthly o yearly
I have the following assets:
1.2. Cash$ dahl}
Homestead real estate $__ ‘N/K
, ,
"
3. Non-homestead real estate $ clit
4. CariMotor Vehicle $__WLC...
5. Boats/othertangible property $ B Lh ¢
de. Money market accounts $ WAP ;
7.8. Bank/Savings account(s) $ofDeposit$
Stocks/bonds/Certificates NLD Wik
W 7
9. | DOs DONOT (select only one) expect to receive more assets soon. The asset(s) and value(s) are
a
CCOAA Printed:
nted: 10/12/2022 3:00:55PM
:00: Ap lpplicant
icant InitiInitials Page
yeAX2Nas
of 4
Fe
GE
fs hex en "\ Kelvin Soto, Esq.
i Bair 4X4 |B] Clerk of the Circuit Court & Comptroller
aEA)
EL £} Osceola County
Ores
Payment Plan Application & Agreement
; ACCEPTABLE PAYMENT METHODS
Section 4 (s. 28.42(2), F.S.)
Payments can be made as follows:
e Online: ww.osceolaclerk.com, select Payment Options > Make a Payment,
e By phone: 888-972-1534,
e By money order or cashier's check. Please include your payment plan number/name and mail to:
. Osceola County Clerk of Court 2 Courthouse Square, Kissimmee, FL 34741,
e Inperson: 2 Courthouse Square, Kissimmee, FL 34741 or
e Visit any Amscot Location.
. PAYMENT PLAN TERMS |
Section 5 (s. 28.42(2), F.S.) |
Injtial | understand that court-imposed financial obligations and civil penalties are penalties from
ER mysentence orsetbyapplicable lawand | am requiredto payforal fines, fees, and costs
7 incurred from my case proceeding({s).
| understand and agree to pay a one-time administrative fee of $25.00 for civil traffic cases
or a monthly administrative fee of $5.00 for criminal cases to establish a payment plan -
(s. 28.24(27)(b) or s. 28.24(27)(c), F.S.).
«If I fail to complete my payment plan and the clerk creates a new payment plan for
me, | understand the clerk will assess an additional $25.00 or $5.00 administrative
fee each time a new payment agreement is established.
- | further understand that nCourt charges a fee of 7 percent for online payments or
es:so 4 3.5percentforin-person
card. payments per payment when making payments by credit |
\ \)\ |regardless
|
understandofe-notification
that it is my responsibilityto
reminders. make timely payments pursuantto the plan,
+ Payment is due no later than 11:59 PM Eastern Standard Time on the date given.
| will timely update my address, cell phone number, email address and any other contact
information with the Clerk's Office so that | may receive notifications. |
Pe) Q - Failing to update my contact information may prevent me from receiving payment
plan notifications.
(I> \>| |plan
will ifnotify the Clerk'ssituation
my financial office changes.
immediately with a request to modify my original payment
. FAILURE TO COMPLY
Section 6
Initial Failing to pay as agreed may result in the Florida Highway Safety and Motor Vehicles
(FLHSMV) issuing an order suspending my driver license and my privilege to drive 20
days after the date the order of suspension is mailed (ss. 318.15 or 322.245, F.S.).
ARES - FLHSMV will send notification of suspension to the address they have on file.
CCOAA ‘
Printed: 10/12/2022 3:00:55PM Applicantives OS_ Page 3 of 4
fe —_
7 ffgSELON
CaosA 5H
fs fax CSdG\ Kelvin Soto, Esq.
sR Part E Clerk of the Circuit Court & Comptroller
aksaf”)
,
ONE ‘gf/ Osceola County
orn
Payment Plan Application & Agreement
If| fail to establish a new payment plan, my license will remain suspended. If my case(s)
remains unpaid after 90 days, my case(s) will be referred to a collection agency (s.
(
fa) AN aa ba 28.246(6), F.S.). agency may add up to a 40 percent fee to my outstanding balance,
: The collection
and | may need to pay the new balance through the collection agency.
| A failure to pay timely, which results in any criminal fine assessed by the court not being
| prays
“ey paid by the date established bythe court, may result in the arrest ofthe defendant for
failure to pay the fine.
# ia
Criminal cases may be subject to a non-refundable lien fee of $22.00.
; COMPLETED BY CLERK’S OFFICE
Section 7 (s. 28.42(2), F.S.)
Reasonableness disclosure: The clerk shall establish all terms of a payment plan, and the court may review the reasonableness of
the payment plan amount. A monthly payment amount, calculated based upon all fees and ail anticipated fees, service charges,
. court costs, and fines, is presumed to correspond to the person's ability te pay if the amount does not exceed 2 percent of the
person's annual net income, as defined in s. 27.52(1}, F.S. divided by twelve.
Payment Plan # Case(s) #: . |
I6@532 200 CT 600863 AeALmm OINZ6
Beginning Eo ile ine ee fi ae
of Fines, Filing Fees, Service Charges, and Court Costs Due $ “179-0oO
| Partial Payment Setup Fee $25.00%one-time or $5.00 monthly x number of
or Monthly Fee Faanths
TotalAmount Due | $ $2 |,cO |
Amount Paid Today $ 75.06
Balance for Payment Plan $ “7Lf6p. CO
Oo
On the Au_ day of each month, beginning $ Soa month
_ Wovenaber _, until balance paid in full. (Monthly payment is considered reasonable if it does not exceed
two percent of annual net income divided by 12.)
The Uniform Payment Plan may be customized by clerks to address local practices, such as the one-time
Partial Payment Setup Fee vs. Monthly Payment Plan Fee, and other issues as long as the resulting
Uniform Payment Plan, as customized, remains substantially similar to this form. ,
CCOAA Printed: 10/12/2022 3:00:55PM ApplicantInitials SQ.
Preview
iELON | LSS FOI 13/f en eA Kelvin Soto, Esq. . z neh Poe 2] Clerk of the Circuit Court & Comptroller We 1 NSS Tone Osceola County Payment Pian Application & Agreement 3 . ACKNOWLEDGEMENT OF TERMS AND FAILURE TO COMPLY CONSEQUENCES Section 1 (s. 28.246(4), F.S.) Initial | attest/confirm/swear that the information provided on this application is true and accurate to the best of my knowledge. ! will abide by the terms of the payment plan and understand ME, A ete failure to obligation financial do so mayandresultpotentially in the suspension my case(s)ofbeing additional collection fees assessed. my driver’s referredlicense forfailureagency to a collection to pay and a | understand that court-imposed financial obligations are penalties from my sentence and LEY. pursuant to F.S. 938.30, ! am required to pay for all fines, fees, and costs incurred from rudd my case proceeding(s). | wish to enroll in a payment plan per s. 28.246(4)(B), F.S. | Applicant Signature il _. Date A atA ! ple: aed . GENERAL INFORMATION Section 2 (s. 28.246(4}(b), F.S.) First Name Middle Name Last Name JESUS ALBERTO GONZALEZ RIVERA Street Address 2400 ASHECROFT DR City State Zip Code KISSIMMEE FL 34744 Date of Birth Driver License or State ID Number 12/24/1986 G524421864640 PAYMENT NOTIFICATIONS Data and message rates may apply. | consent to payment notifications by email Email Address 1 Yes OUNo Tconsent to automated notifications by phone] ! consent to payment notifications by text message O Yes ONo Ol Yes OINo Phone Number Cell Phone RECEIVED ° OAT 42 alee | Clerk of Court CCOAA Printed: 10/12/2022 3:00:55PM ApplicantInitials , ek Page iof4 ~" Pe - ELT Co Y TEXa) Kelvin Soto, Esq. i oe !| Clerkofthe henwea CircuitCourt& Comptroller Osceola County | _. Sai: Payment Plan Application & Agreement Section 3 FINANCIAL INFORMATION | How much can you afford to pay per month? $ a O). | How much can you afford to pay as a down payment? $ SS" My net income pay is $ 49,0. (select only one): a weekly 0 bi-weekly Oo monthly O sem+monthly O yearly Total net annual income pay consists of total salary and wages, minus deductions required by law, including court-ordered support payments. - s. 27.52(1), F.S. | 1. Social Security benefits $ Web D weekly o bi-weekly o monthly a semimonthly o yearly | My Income sources are: 94.3.. Unemploymentcompensation$ Reemployment Assistance $ Union funds $ bh isec. ry, i 0 weeklyg weekly O bi-weekly bi-weekly oO monthly monthly oo semimonthly9 semimonthly O yearly yearly o weekly m bi-weekly o monthly o semi+monthly a yearly - 5. Retirement/pensions $ wt T- O weekly o bi-weekly | monthly sem-monthly o yearly , | 6. Trusts or gifts $ \ ifreal 0 weekly o bi-weekly o monthly o semimonthly a yearly | 7. Veterans’ benefit $ Pe D weekly o bi-weekly o monthly a semi#-monthly o yearly. } . 8. Worker's compensation $ ene O weekly o bi-weekly a monthly o semimonthly a yearly 9. Rental income $ WYLe oO weekly o bi-weekly o monthly o semi-monthly o yearly | 10. Dividends or interest $ iN, Le o weekly o bi-weekly o monthly o semimonthly O yearly | 141. Support from family members $ nb LAX... o weekly o bi-weekly o monthly o sem-monthly o yearly 412. Other income not on the list $. f Ve . o weekly o bi-weekly o monthly o semi-monthly o yearly I have the following assets: 1.2. Cash$ dahl} Homestead real estate $__ ‘N/K , , " 3. Non-homestead real estate $ clit 4. CariMotor Vehicle $__WLC... 5. Boats/othertangible property $ B Lh ¢ de. Money market accounts $ WAP ; 7.8. Bank/Savings account(s) $ofDeposit$ Stocks/bonds/Certificates NLD Wik W 7 9. | DOs DONOT (select only one) expect to receive more assets soon. The asset(s) and value(s) are a CCOAA Printed: nted: 10/12/2022 3:00:55PM :00: Ap lpplicant icant InitiInitials Page yeAX2Nas of 4 Fe GE fs hex en "\ Kelvin Soto, Esq. i Bair 4X4 |B] Clerk of the Circuit Court & Comptroller aEA) EL £} Osceola County Ores Payment Plan Application & Agreement ; ACCEPTABLE PAYMENT METHODS Section 4 (s. 28.42(2), F.S.) Payments can be made as follows: e Online: ww.osceolaclerk.com, select Payment Options > Make a Payment, e By phone: 888-972-1534, e By money order or cashier's check. Please include your payment plan number/name and mail to: . Osceola County Clerk of Court 2 Courthouse Square, Kissimmee, FL 34741, e Inperson: 2 Courthouse Square, Kissimmee, FL 34741 or e Visit any Amscot Location. . PAYMENT PLAN TERMS | Section 5 (s. 28.42(2), F.S.) | Injtial | understand that court-imposed financial obligations and civil penalties are penalties from ER mysentence orsetbyapplicable lawand | am requiredto payforal fines, fees, and costs 7 incurred from my case proceeding({s). | understand and agree to pay a one-time administrative fee of $25.00 for civil traffic cases or a monthly administrative fee of $5.00 for criminal cases to establish a payment plan - (s. 28.24(27)(b) or s. 28.24(27)(c), F.S.). «If I fail to complete my payment plan and the clerk creates a new payment plan for me, | understand the clerk will assess an additional $25.00 or $5.00 administrative fee each time a new payment agreement is established. - | further understand that nCourt charges a fee of 7 percent for online payments or es:so 4 3.5percentforin-person card. payments per payment when making payments by credit | \ \)\ |regardless | understandofe-notification that it is my responsibilityto reminders. make timely payments pursuantto the plan, + Payment is due no later than 11:59 PM Eastern Standard Time on the date given. | will timely update my address, cell phone number, email address and any other contact information with the Clerk's Office so that | may receive notifications. | Pe) Q - Failing to update my contact information may prevent me from receiving payment plan notifications. (I> \>| |plan will ifnotify the Clerk'ssituation my financial office changes. immediately with a request to modify my original payment . FAILURE TO COMPLY Section 6 Initial Failing to pay as agreed may result in the Florida Highway Safety and Motor Vehicles (FLHSMV) issuing an order suspending my driver license and my privilege to drive 20 days after the date the order of suspension is mailed (ss. 318.15 or 322.245, F.S.). ARES - FLHSMV will send notification of suspension to the address they have on file. CCOAA ‘ Printed: 10/12/2022 3:00:55PM Applicantives OS_ Page 3 of 4 fe —_ 7 ffgSELON CaosA 5H fs fax CSdG\ Kelvin Soto, Esq. sR Part E Clerk of the Circuit Court & Comptroller aksaf”) , ONE ‘gf/ Osceola County orn Payment Plan Application & Agreement If| fail to establish a new payment plan, my license will remain suspended. If my case(s) remains unpaid after 90 days, my case(s) will be referred to a collection agency (s. ( fa) AN aa ba 28.246(6), F.S.). agency may add up to a 40 percent fee to my outstanding balance, : The collection and | may need to pay the new balance through the collection agency. | A failure to pay timely, which results in any criminal fine assessed by the court not being | prays “ey paid by the date established bythe court, may result in the arrest ofthe defendant for failure to pay the fine. # ia Criminal cases may be subject to a non-refundable lien fee of $22.00. ; COMPLETED BY CLERK’S OFFICE Section 7 (s. 28.42(2), F.S.) Reasonableness disclosure: The clerk shall establish all terms of a payment plan, and the court may review the reasonableness of the payment plan amount. A monthly payment amount, calculated based upon all fees and ail anticipated fees, service charges, . court costs, and fines, is presumed to correspond to the person's ability te pay if the amount does not exceed 2 percent of the person's annual net income, as defined in s. 27.52(1}, F.S. divided by twelve. Payment Plan # Case(s) #: . | I6@532 200 CT 600863 AeALmm OINZ6 Beginning Eo ile ine ee fi ae of Fines, Filing Fees, Service Charges, and Court Costs Due $ “179-0oO | Partial Payment Setup Fee $25.00%one-time or $5.00 monthly x number of or Monthly Fee Faanths TotalAmount Due | $ $2 |,cO | Amount Paid Today $ 75.06 Balance for Payment Plan $ “7Lf6p. CO Oo On the Au_ day of each month, beginning $ Soa month _ Wovenaber _, until balance paid in full. (Monthly payment is considered reasonable if it does not exceed two percent of annual net income divided by 12.) The Uniform Payment Plan may be customized by clerks to address local practices, such as the one-time Partial Payment Setup Fee vs. Monthly Payment Plan Fee, and other issues as long as the resulting Uniform Payment Plan, as customized, remains substantially similar to this form. , CCOAA Printed: 10/12/2022 3:00:55PM ApplicantInitials SQ.