Ability to Pay - Plea Accepted

Ability to Pay - Plea Accepted / Judgment Entered

* indicates a required field

First Name*

Last Name*

Citation / Ticket / Cause Number*

Violation/Offense*

Street / PO Box*

City*

State*

Zip Code*

Email Address*

Confirm

Phone Number*

I entered a plea of no contest/guilty to the above-referenced charge and requested the following option*

I am unable to pay fine/costs ordered by the Judge. I request the Judge to consider alternatives to payment due to my circumstances listed. I understand I may need to complete and submit a Financial Form with documentation.

You are REQUIRED to submit Proof of Identification.

If you are unable to upload your identification with this form, email a copy to IMC@INGLESIDETX.GOV

THIS FORM WILL NOT BE ACCEPTED UNLESS REQUIRED IDENTIFICATION HAS BEEN RECEIVED!

Proof of Indigency, if applicable

Upload Driver's License/Identification*

By typing my name-I adopt this as my signature and have read, affirm and agree to the information herein-Defendant Signature*

Defendant Signature

Date*