Payment Agreement

FILED
Fourth Judicial District
Hennepin County
OCI a 4 r2016

DIS‘I:
Name MARKJOHNATHAN EVERETTE COURTADMINISTRATOR
Citation(s):881802530737 DEPUTY
Case(s) 27-VB-18-289497

Total Balance due $145.00

This amount must be paid on or before Friday, November 23, 2018 .

Failure to pay or appear by the due dates show may result in additional fees added to each citation, a

warrant may be issued for your arrest, your driver’s license may be suspended, and/or your account
may be referred to a collection agency, which has collection authority and may access non-public
government data on you for the purpose of collecting this debt.

A agency and/or Hennepin County may take the following actions: offset your state income
collection
tax refund, tow your vehicle, seek a judgment against you and/or your property, levy your bank funds,
seize property, revoke or deny renewal of a professional license, garnish your wages, issue a subpoena,
refer your account to a private collection agency, and file a credit bureau reports.

Ihave pled guilty t0 the above citations and | agree to notify the Court within five (5) days of any change
in address, phone number or employment. By signing this form, | agree to abide by the terms and
conditions of this Payment Agreement.

To Pay Online: By MasterCard or Visa, access www.mncourts.gov

To Pay by Phone: Using MasterCard or Visa, call 1-800-657-3611 or 651-281—3219 (metro)

To Pay by Mail: Check or Money Order Payable to Court Administration (in US dollars) to:

Minnesota Court Payment Center

P.O. Box 898

Defendant SEMW
Willmar,

_
MN 56201

mm i

10/24/2018