Defendant's Name ____________________________________ Address ____________________________________________ City, State, Zip Code __________________________________ Telephone No. _______________________________________
Choose One IN THE DISTRICT COURT OF THE ____________ CIRCUIT State of Hawai#i Choose One ________________ DIVISION
STATE OF HAWAI`I, ) ) vs. ) ) ____________________________ ) Defendant. ) ____________________________________) Case ID/Citation No.: __________________________________ DEFENDANT'S MOTION TO CONVERT FINE AND/OR MONETARY ASSESSMENT
DEFENDANT'S MOTION TO CONVERT FINE AND/OR MONETARY ASSESSMENT I, _____________________________________, have an unpaid fine and/or monetary
(Print Name)
assessment of $______________, ordered in the judgment entered on ____________________.
(Amount) (Date)
I request that the Court convert this fine/monetary assessment to: G G Community service work hours; OR Jail (for criminal convictions ONLY).
Dated: ____________________, Hawaii, _____________________.
(City) (Date)
__________________________________ Signature of Defendant
Rev. 21 August 2006 1DC
Reprographics (10-06)
Reset Form
1D-P-1221