Town of Pinetop/Lakeside - Magistrate Court Payments

Payments

Fill out form and print two copies, one to be mailed and one for your files.

PAYMENT OF FINES

If you want to pay the fine(s) by mail and avoid appearing in court, the following form is available
for your convenience. Fill out the form, print out the form, sign the form and mail the it along with
your payment. THIS IS NOT AN EMAIL FORM AND CANNOT BE SENT VIA EMAIL. If you use this
option, a court appearance is not required.

I do not want a hearing or trial.	Yes No
I agree to pay the fine(s).	Yes No
Name
Mailing Address
City	State Zip
Phone
Complaint Number	This number can be found on the top left-hand corner of your ticket. Write this number on your check also.
Amount For Each Violation	Violation A Fine Amount Violation B Fine Amount Violation C Fine Amount Violation D Fine Amount Violation E Fine Amount Look at the ticket and find the violation(s). Look at the fine schedule found on the Court Magistrate Page
Subtotal
*Late Fee
*Criminal FTA fee
*Civil Traffic Default Fee
**Payment Schedule Fee
Total
Signature I request that the court collection department contact me to arrange a payment schedule. I have followed all steps above.

DO NOT SEND CASH. Cashiers checks and money orders ok. Mail your payment with this form to the court.

Town of Pinetop-Lakeside Magistrate Court

P.O. Box 860

Lakeside, Arizona 85929

Payment in full must be received or postmarked before your court date, or extra fees must be added.
*If you are late in a civil traffic violation, a $30 default fee and $20 late fee must be added. If you fail to
appear in a criminal or criminal traffic violation, a $153 failure to appear fee and a $20 late fee must be
added.
**If you are unable to pay the amount in full, you must arrange a payment schedule prior to your court
date: a $20 payment schedule fee must be added.