N THE________________________________________COURT OF____________________________________,ALABAMA 
 
 

(Circuit or District)  

(Name of County)  

 

 

 

 

 STATE OF ALABAMA v. _____________________________________________________________________________ 
 

    Defendant  

 

 

 

 

 

 

     This cause coming to be heard on the ______________ day of _____________________, __________, in the presence 
of the District Attorney, the defendant, and __________________________________________________________________, 
as defense attorney, the court finds as follows:  

.  The defendant owes the following:  

Court Costs  . . .. . . . . . . . . . . . . . . . . . . . . . . .. .  $ _________________ Demand Reduction Assessment (if assessed by the court . . .  $ ___________ 
Fines  . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . $ _________________          (See Section 13A-12-281, Ala. Code 1975)  
Restitution (plus a $1.00 Administrative Fee with  

                               each periodic payment to the clerk) . . . . . . .  $ _________________ Other (specify) . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . .   $ ___________ 
           Appointed Counsel Fees and Expenses . . . . . $ _________________  . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . .. . .  . . . . . . . . . . . . . . . . . .    $ ___________ 
           Victim Compensation Assessment . . . . . . . . .  $ _________________ . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . .. . .  . . . . . . . . . . . . . . . . . .  $ ___________ 
                 (See Section 15-23-17(b), Ala. Code 1975) 
          

                 TOTAL AMOUNT OWNED BY DEFENDANT . . . . . . . . . . . . . . . .  $ ___________ 

 

 

 

 

 

2.  The victim’s name is indicated in the court records ________________________________________________________. 
3.  The defendant’s social security number is ______________________________.  
4.  The defendant is currently employed by ________________________________________________________________.  
Address: _________________________________________________________________________________________ 
5.  The defendant is obligated to pay child support in the amount of $________________per_________________________.  
6.  The defendant’s employment income (less child support obligation) is $______________per_______________________. 

This amount is subject to restitution withholding.  

7.  The Defendant is currently being garnished in the amount of $__________________per __________________to satisfy  

a judgment in the amount of $______________payable to__________________________________________________. 

8.  The co-defendant is__________________________________________, Case Number __________________________.  

________________________________________________________________________________________________. 

         This court having the authority to impose or order the above-named defendant to pay certain amounts of money to the 
clerk  and  this  court  having  considered  all  the  factors  required  by  law  to  be  considered,  IT  IS  HEREBY  ORDERED  AS 
FOLLOWS:  
1. 

The defendant shall pay the amounts indicated in paragraph 1 above, plus a $1.00 administrative fee with each periodic 
payment of restitution to the clerk.  

2.  (cid:133) The total amount shall be paid in FULL by (date) _______________________________.  

(cid:133) The total amount shall be paid in INSTALLMENTS commencing on (date)___________________________________ 
in amount of $_____________ per __________________________ until paid in full.  
(cid:133) Reference is hereby made to a separate income withholding order for fines, costs, restitution, and other court-ordered 
monies.  

5. 

4. 

3.  Monies shall be paid to the CLERK____________________________________________________________________ 
Address: ________________________________________________________________________________________ 
Payment  of  the  amount(s)  indicated  above  shall  be  a  condition  of  probation,  parole,  work  release,  SIR,  or  any  other 
release program.  
The  Alabama  Department  of  Corrections,  the  Alabama  Board of Pardons and Paroles and/or any other agency having 
lawful custody of the above-name defendant shall collect or withhold from any sources of money received by the prisoner 
at  the  rate  of  ______%  and  forward  monies  collected  or  withheld  to  the  clerk  of  this  court  in  payment  of  fines,  costs, 
restitution, and other court-ordered monies as ordered above.  
This court retains jurisdiction of this defendant and this matter until all monies ordered paid herein are paid in full.  
_______________________________________________________________________________________________. 

6. 

rdered this (date) _____________________________                 ______________________________________________ 

         Judge 

 COPY OF THIS ORDER SHOULD BE FURNISHED TO:                  District Attorney, Victim, Defense Attorney, Defendant, Probation Officer/Parole Officer, Department of 

 

 

 

 

Corrections, Board of Pardons and Paroles, Crime Victim Compensation Commission, Employer. 

 

 

  O

  A

 

 

ase Number  

  C

State of Alabama  
Unified Judicial System  

orm C-79                       Rev.6/96 

ORDER 
REQUIRING DEFENDANT TO PAY CERTAIN 
AMOUNT(S) OF MONEY TO THE CLERK OF COURT 

    F

  I

  (cid:133)

 

   

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