Form Jdf 230 - Notice Of Withdrawal Of Intent To Pursue Collection By Victim
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1County Court
District Court
Denver Juvenile Court
_____________________________County, Colorado
Court Address:
State of Colorado
v
Defendant: _____________________________
COURT USE ONLY
Attorney or Party Without Attorney (Name and Address):
Case Number
Phone Number:
E-mail:
FAX Number:
Atty. Reg. #:
Division
Courtroom
NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM
Pursuant to §16-18.5-107, C.R.S., 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 §16-18.5-107,C.R.S., as amended.
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 of Title 16, C.R.S., as amended.
Dated: ________________________ (today’s date)
_____________________________________
Signature of Victim
______________________________________
Type/Print Name of Victim
Note: Address/Telephone number is optional.
Address: ______________________________
City: _____________________ State: ______
Telephone: ____________________________
Subscribed and affirmed, or sworn to before me in the County of ________________________, State of
____________________, this _______, day of ________________, 20 _____.
My Commission Expires: ___________________
______________________________________
Notary Public/Deputy Clerk
JDF 230
R7/06
NOTICE OF WITHDRAWAL OF INTENT TO PURSUE COLLECTION BY VICTIM
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