Payment Type:  Probation Fees   Electronic Monitoring Fees   Community Service Fees  Court Case No: Example: 00CR00001C Defendant's First Name: Defendant's Last Name: Defendant's Date of Birth: --select--  January  February  March  April  May  June  July  August  September  October  November  December / --select--  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31 / --select--  1910    1911    1912    1913    1914    1915    1916    1917    1918    1919    1920    1921    1922    1923    1924    1925    1926    1927    1928    1929    1930    1931    1932    1933    1934    1935    1936    1937    1938    1939    1940    1941    1942    1943    1944    1945    1946    1947    1948    1949    1950    1951    1952    1953    1954    1955    1956    1957    1958    1959    1960    1961    1962    1963    1964    1965    1966    1967    1968    1969    1970    1971    1972    1973    1974    1975    1976    1977    1978    1979    1980    1981    1982    1983    1984    1985    1986    1987    1988    1989    1990    1991    1992   Payer's First Name: Payer's Last Name: Mailing Address: City: State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Phone: Email: Amount Paid: $ Comments: OR Pay By Electronic Check: ENTER ALL DIGITS FROM LEFT TO RIGHT ALONG BOTTOM OF CHECK BOX 1 BOX 2 BOX 3 *(Please follow the following instructions when filling out your check information.) 1. BOX 1: Fill in your Nine Digit Routing Number. 2. BOX 2: Fill in your Account Number. 3. BOX 3: Fill in your Check Number. Questions: Please call the Department of Alternative Sentencing at:775.887.2528

IMPORTANT INFORMATION: Payments may take up to three business days to process. If you have any questions, contact. the Department of Alternative Sentencing at 775-887-2528 or in person at 885 East Musser Street, Suite 2080, Carson City, Nevada 89701.