Free County Court District Court Denver Juvenile Court _____________________________C... - Colorado



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County Court District Court Denver Juvenile Court _____________________________County, Colorado Court Address: State of Colorado v Defendant: _____________________________ Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: E-mail: Atty. Reg. #: COURT USE ONLY Case Number Division Courtroom NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM Pursuant to 16-18.5-107, C.R.S., as amended, the below named person (or entity) hereby notifies the Court, the Collections Investigator, and the Department of Corrections, if defendant was sentenced thereto, of his or her WITHDRAWAL of intent to pursue collection of restitution in his or her own name. It is further stated that: 1. The below named person is a victim in whose name a restitution order has been entered by this Court. 2. That such order was entered o

County Court District Court Denver Juvenile Court _____________________________County, Colorado Court Address:

State of Colorado v Defendant: _____________________________ Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: E-mail: Atty. Reg. #: COURT USE ONLY Case Number

Division

Courtroom

NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM
Pursuant to 16-18.5-107, C.R.S., as amended, the below named person (or entity) hereby notifies the Court, the Collections Investigator, and the Department of Corrections, if defendant was sentenced thereto, of his or her WITHDRAWAL of intent to pursue collection of restitution in his or her own name. It is further stated that:

1. The below named person is a victim in whose name a restitution order has been entered by this Court. 2. That such order was entered on ________________________ (date of order). 3. That the amount of outstanding restitution still owed to this victim as shown by the victim's record is
$_____________ (attach documentation of defendant's payments to victim).

4. That the below named person wishes to exercise his or her right to withdraw from pursuit of collection of
restitution in his or her own name pursuant to 16-18.5-107,C.R.S., as amended.

5. That the Notice of Intent to Pursue Collection by Victim was delivered to the Clerk of the Court or, if the
Defendant was sentenced to the Department of Corrections, to the Executive Director of the Department of Corrections on _______________________ (date delivered). 6. That upon receipt of this Notice of Withdrawal the Collections Investigator or the Department of Corrections shall pursue collection of restitution pursuant to Article 18.5 of Title 16, C.R.S., as amended.

Dated: ________________________ (today's date)

_____________________________________ Signature of Victim ______________________________________ Type/Print Name of Victim Note: Address/Telephone number is optional. Address: ______________________________ City: _____________________ State: ______ Telephone: ____________________________

Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______, day of ________________, 20 _____. My Commission Expires: ___________________ ______________________________________ Notary Public/Deputy Clerk

JDF 230

R7/06

NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM

File Size: 93.3 kB
Pages: 1
Date: June 30, 2006
File Format: PDF
State: Colorado
Category: Court Forms - State
Author: b888hb
Word Count: 327 Words, 2,450 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.co.us/Forms/PDF/jdf230.pdf