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Notice Of Withdrawal Of Intent To Pursue Collection By Victim JDF 230 - Colorado
| Notice Of Withdrawal Of Intent To Pursue Collection By Victim Form. This is a Colorado form and can be used in General Statewide . |
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County Court District Court Denver Juvenile Court _____________________________County, Colorado Court Address: State of Colorado v Defendant: _____________________________ Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number Phone Number: E-mail: FAX Number: Atty. Reg. #: Division Courtroom NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM Pursuant to Article 16, Title 18.5, Section 107 of the Colorado Revised Statutes, as amended, the below named person (or entity) hereby notifies the Court, the Collections Investigator, and the Department of Corrections, if defendant was sentenced thereto, of his or her WITHDRAWAL of intent to pursue collection of restitution in his or her own name. It is further stated that: 1. The below named person is a victim in whose name a restitution order has been entered by this Court. 2. That such order was entered on ______________________ (date of order). 3. That the amount of outstanding restitution still owed to this victim as shown by the victim's record is $_____________ (attach documentation of defendant's payments to victim). 4. That the below named person wishes to exercise his or her right to withdraw from pursuit of collection of restitution in his or her own name pursuant to ยง6-18.5-107(4) C.R.S. 5. That the Notice of Intent to Pursue Collection by Victim was delivered to the Clerk of the Court or, if the Defendant was sentenced to the Department of Corrections, to the Executive Director of the Department of Corrections on _______________________ (date delivered). 6. That upon receipt of this Notice of Withdrawal the Collections Investigator or the Department of Corrections shall pursue collection of restitution pursuant to Article 18.5, Title 16, C.R.S. Dated: ____________ (today's date) ___________________________________ Signature of Victim ___________________________________ Typed/Printed Name of Victim __________________________________ Notary Public/Deputy Clerk My Commission Expires: __________________ Address: __________________________ Telephone: _________________________ JDF 230 6/05 NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM American LegalNet, Inc. www.USCourtForms.com
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