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2. LAKE FOREST PARK MUNICIPAL COURT - TIME PAY AGREEMENT
4. Case Number(s):*
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone number:*
18. Email:*
20. I promise to pay (total amount due):*
21. OR
22. I promise to make monthly payments of:
24. PAY IN FULL DATE:*
    PAY IN FULL DATE:
25. OR
26. FIRST PAYMENT DATE:*
    FIRST PAYMENT DATE:

28. Submitting a Payment:

    • Mail a check or money order to the address listed above (NO FEES ADDED)
    • Pay online at www.lfptix.com (6% nCourt fee will be added)
    • Pay by phone: 206-905-7447,  (6% nCourt fee will be added)
    • Visit our front counter: Monday through Friday, excluding holidays. 

    Open 9:00 am – 5:00 pm,  - pay with cash (EXACT AMOUNT REQUIRED), credit or debit card (3% nCourt fee added), personal check or money order. 

30. NOTICE: If you fail to pay in full any monetary obligation imposed by the Judge or you fail to enter into a payment plan with the Court, you will be assessed an additional $52 default penalty for traffic tickets and a $25 default penalty for parking and photo tickets. In addition, the ticket may be referred to a collection agency and collection costs may be imposed and your wages or assets may be garnished. Failure to pay in full or set up a payment plan may also result in a suspension of your driver’s license or a renewal hold placed on your vehicle license registration.

32. Electronic Signature of Defendant*

    1. I agree. Electronic Signature.

    By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
33. Electronic Signature of Defendant*
    Last name, first name, middle initial
35. Date signed:*
    Date signed:
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field