Flagstaff, AZ · Coconino County
Payment Plan and Community Restitution Financial Statement
Flagstaff Municipal Court uses this financial statement to assess payment plan eligibility for people who cannot pay fines and fees in full.
What this form is
People who cannot pay their fines and fees in full complete this statement so the Flagstaff Municipal Court can consider their financial circumstances when determining payment plan eligibility. It asks for case and contact details, employment, assets, monthly income, and expenses. The form also states that a $30 time payment fee will be assessed if the case is not paid in full on the date the fine is imposed and the person proceeds with a payment plan.
Who needs it
People asking Flagstaff Municipal Court to consider a payment plan because they cannot pay their fines and fees in full need this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This statement is signed without a notary; the signer affirms under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Form
Download the Payment Plan and Community Restitution Financial Statement.
- 2
Complete The Statement
Fill it out thoroughly and legibly. Enter N/A for items that do not apply.
- 3
Review Your Information
Include only income you personally receive and expenses for which you are financially responsible.
- 4
Sign And Date
Sign and date the statement, affirming under penalty of perjury that the information is true and correct.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Payment Plan and Community Restitution Financial Statement?
- No. The document has no notary block; the signer signs and affirms under penalty of perjury that the information is true and correct.
- Who uses this financial statement?
- People who cannot pay court fines and fees in full complete it so Flagstaff Municipal Court can consider their financial circumstances when deciding whether they qualify for a payment plan.
- What information does the statement ask for?
- It requests case and contact details, employment information, assets, monthly income, and monthly expenses. It also includes a signature and date field.
- How do I submit the financial statement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Payment Plan and Community Restitution Financial Statement doesn’t need a notary — but if you have another Flagstaff form that does, a commissioned online notary can help.