Free Convert Fine and/or Monetary Assessment - Hawaii

Defendant's Name ____________________________________ Address ____________________________________________ City, State, Zip Code __________________________________ Telephone No. _______________________________________

Choose One IN THE DISTRICT COURT OF THE ____________ CIRCUIT State of Hawai#i Choose One ________________ DIVISION
STATE OF HAWAI`I, ) ) vs. ) ) ____________________________ ) Defendant. ) ____________________________________) Case ID/Citation No.: __________________________________ DEFENDANT'S MOTION TO CONVERT FINE AND/OR MONETARY ASSESSMENT

DEFENDANT'S MOTION TO CONVERT FINE AND/OR MONETARY ASSESSMENT I, _____________________________________, have an unpaid fine and/or monetary
(Print Name)

assessment of $______________, ordered in the judgment entered on ____________________.
(Amount) (Date)

I request that the Court convert this fine/monetary assessment to: G G Community service work hours; OR Jail (for criminal convictions ONLY).

Dated: ____________________, Hawaii, _____________________.
(City) (Date)

__________________________________ Signature of Defendant

Rev. 21 August 2006 1DC
Reprographics (10-06)

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1D-P-1221