Free IN THE DISTRICT COURT FOR THE STATE OF ALASKA AT ANCHORAGE - Alaska

IN THE DISTRICT COURT FOR THE STATE OF ALASKA AT PLEA FORM/DEFERRED OBLIGATION Print Defendant's Name: Citation No(s): I hereby enter a plea of NO CONTEST. I do not wish to contest this citation. I have read and signed the rights explained on form TR-210, and I understand that my NO CONTEST plea means: (1) I am giving up my right to a trial and the other rights listed on form TR-210, (2) A judgment of conviction will be entered against me, (3) If this is a traffic case: the conviction may result in administrative action against my driver's license by the Division of Motor Vehicles, and (4) If this is a fish and game case: Any fish, game or equipment seized and listed on the face of the citation will be forfeited to the State of Alaska and, if I have a prior conviction for a fish and game offense, an action may be filed to revoke my license under AS 16.05.410(g). I request that the bail or fine I am paying be used to satisfy this citation. DEFERRED OBLIGATION: I agree to make full payment in the amount of $ by . I understand that if I fail to make full payment by that date, efforts will be made to collect the judgment, including attachment of my Permanent Fund Dividend. If a writ of execution is issued to collect this fine, an additional $25 for collection costs will be added to the judgment in this case. Defendant's Signature: Mailing Address TR-216 (4/98) (st.2) (4 ¼ x 8 ½) Date: Day Telephone:

IN THE DISTRICT COURT FOR THE STATE OF ALASKA AT PLEA FORM/DEFERRED OBLIGATION Print Defendant's Name: Citation No(s): I hereby enter a plea of NO CONTEST. I do not wish to contest this citation. I have read and signed the rights explained on form TR-210, and I understand that my NO CONTEST plea means: (1) I am giving up my right to a trial and the other rights listed on form TR-210, (2) A judgment of conviction will be entered against me, (3) If this is a traffic case: the conviction may result in administrative action against my driver's license by the Division of Motor Vehicles, and (4) If this is a fish and game case: Any fish, game or equipment seized and listed on the face of the citation will be forfeited to the State of Alaska and, if I have a prior conviction for a fish and game offense, an action may be filed to revoke my license under AS 16.05.410(g). I request that the bail or fine I am paying be used to satisfy this citation. DEFERRED OBLIGATION: I agree to make full payment in the amount of $ by . I understand that if I fail to make full payment by that date, efforts will be made to collect the judgment, including attachment of my Permanent Fund Dividend. If a writ of execution is issued to collect this fine, an additional $25 for collection costs will be added to the judgment in this case. Defendant's Signature: Mailing Address TR-216 (4/98) (st.2) (4 ¼ x 8 ½) Date: Day Telephone: