In The County Court Of The Fourteenth Judicial Circuit In And For Jackson County, FloridaCase Number:This is the Case Number Associated with your Traffic CitationCitation Number:*This is the Citation NumberDate Of Ticket* First Payment must be paid in full within 30 days of the date the ticket was issued!!!STATE OF FLORIDA VS.* First Last Ticket Price:*Ticket Monthly Installment*CIVIL INFRACTION PARTIAL PAYMENT AGREEMENTYou, the Defendant, have elected to pay partial payments to the Jackson County Clerk of Courts. You represent that you are unable to pay the civil infraction due on this case without a payment plan. You will pay the amount owed plus an administrative fee of $25.00 (one-time fee) pursuant to this Partial Payment Agreement. Defendant Submits The Following Financial/Contact Information:Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Main Phone*Work PhoneOther PhoneEmail* Enter Email Confirm Email The Defendant Agrees As Follows:1. Acceptable forms of payment are cash, money order, cashier’s check, certified check; debit or credit card. 2. Defendant will pay the one-time fee of $25.00 + The first Monthly Installment with this agreement. 3. DEFENDANT AGREES TO PAY THE FIRST INSTALLMENT PLUS $25.00:*The first installment including the $25.00 Fee.First Payment must be paid in full within 30 days of the date the ticket was issued!!!Remaining Balance must be paid in full within by the fourth month starting from when the initial payment was made!!!Remaining Balance:*Monthly Payments:*For next 3 months.4. Payments may be paid before the due date and/or for more than the agreed upon amount without penaltyOATH: It is hereby acknowledged by the undersigned that all funds due must be paid to the Jackson County Clerk of Court by cash, money order, cashier's check, certified check, debit or credit card in the amounts and on the dates specified by this payment agreement. Please include the case number when sending payments by mail. As part of the agreement, the above named individual hereby certifies that the personal information provided is true and correct and any changes will be immediately provided to the Clerk's Office.Check the box below to acknowledge you have read the oath and all of the personal information is true and correct:* I Agree EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.