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2. *** Disclaimer***

   This is a request for the Plea of Guilty Without Personal Appearance Payment Plan Program. To be eligible, you must currently be enrolled in the Plea of Guilty Without Personal Appearance Program. If you are not enrolled, your request will be denied.

4. Plea Payment Plan

   This is a 90-day payment plan. Payments can be made by mail (no cash), in person, or over the phone during normal business hours of 9 AM to 4 PM, Monday to Friday. You may also pay online at www.bratenahl.org/Online Payments and Docket Information.

6. Date *
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7. Citation Number *
9. First Name*
10. Last Name*
12. Phone Number*
13. Email Address*
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15. 1. Receive an email copy of this form.
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