This is an alternate format of Form 126and 125 prepared for persons with disabilities. Note to screen-reader users: Use the arrow keys to navigate through this form instead of the tab key.
Form 126:
Order Extending Time for Payment
Courts of Justice Act
Under section 66 of the Provincial Offences Act
R.R.O. 1990
O. Reg. 200
ONTARIO court of justice
Province of ontario
Upon reading the attached motion of
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dated the
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day of
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POA 0809 (November 2003) CSD / Page 1 of 8year
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POA 0809 (November 2003) CSD / Page 1 of 8it is hereby ordered that the time for payment of the fine (including cost and Victim Surcharge) mentioned therein(check appropriate box)
A
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is extended to the
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POA 0017 (March 2005) CSD Page 1 of 5
day of
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,
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year
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POA 0017 (March 2005) CSD Page 1 of 5
B
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POA 0017 (March 2005) CSD Page 1 of 5
is extended to the
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day of
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to allow for the following periodic payments:
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is not extended for the following reasons:
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Ordered at
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this
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day of
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If extension granted, Defendant’s current address:
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Justice of the Peace in and for the Province of Ontario
Form 125:
Motion for Extension of Time to Pay
Courts of Justice Act
Under section 66(6) of the Provincial Offences Act
R.R.O. 1990
O. Reg. 200
ONTARIO court of justice
Province of ontario
1.
I,
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of
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was convicted in Ontario Court of Justice at
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on the
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day of
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POA 0809 (November 2003) CSD / Page 1 of 8of the offence of
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contrary to
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section
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and was sentenced to pay a fine of
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(including cost and Victim Fine Surcharge).
2.
I was given
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days
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months
to pay this amount.
3.
I have paid
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in satisfaction of the above amount.
4.
I am unable to pay this amount within the time given for the payment for the following reasons:
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I hereby apply for an extension of time for payment until the
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day of
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year
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I am
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years of age.
7.
I am (check one)
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employed.
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unemployed
8.
(check one)
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This is my first application for an extension.
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I previously obtained
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extension(s) of time for payment, the last of which
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expired
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will expire upon the
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day of
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POA 0809 (November 2003) CSD / Page 1 of 8Dated at
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this
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day of
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Signature
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