Form # 423
VERMONT JUDICIAL BUREAU 82 RAILROAD ROW PO BOX 607 WHITE RIVER JCT, VT 05001 Phone: 802-295-8869 Fax: 802-296-5539 REQUEST FOR EXTENSION OF TIME TO PAY FINE
DEFENDANT Name Address
Date of Birth Phone #: (
I, more time to pay my fine.
, Defendant request that the Court grant me
I need more time to pay my fine due to the following reasons:
I will have my fine paid in full by Date (mm/dd/yyyy) SIGNATURE REQUIRED Printed name
* NOTICE: A $30.00 partial payment for each violation must be included with a request for an extension of time to pay.