Form 9-312A. Receipt for cash, money order, or cashier's check.

[For use in the magistrate and municipal courts] STATE OF NEW MEXICO [COUNTY OF _______________] [CITY OF __________________] IN THE __________________ COURT STATE OF NEW MEXICO [COUNTY OF _______________] [CITY OF __________________] v. No. __________ _______________________________, Defendant. RECEIPT FOR CASH, MONEY ORDER, OR CASHIER’S CHECK Defendant information: Arrest date: ________________________________________________ Date of birth: ________________________________________________ Mailing address: ________________________________________________ City, state & zip code: ________________________________________________ Address (physical) (if different from mailing address): ________________________________________________ City, state & zip code: ________________________________________________ Telephone number: ________________________________________________ (Include current telephone number or contact information in case a refund is due.) (Fill in only if $10,000 or more is paid.) Tax ID number or Social Security number of Defendant: ________________________________________________ Occupation, profession or business: ________________________________________________ Payment information: Date of payment: ________________________________________________ Amount paid: ________________________________________________ Number of money order or cashier’s check: ________________________________________________ Issuer: ________________________________________________ Payment made by: ________________________________________________ (print name) Mailing address of person paying cash, money order, or cashier’s check if person paying is not defendant: ________________________________________________ City, state & zip code: ________________________________________________ Telephone number: ________________________________________________ (Include current telephone number or contact information in case a refund is due.) (Fill in only if $10,000 or more is paid.) Tax ID number or social security number of person paying: ________________________________________________ Occupation, profession or business: ________________________________________________ PERSON OTHER THAN DEFENDANT PAYING CASH, MONEY ORDER, OR CASHIER’S CHECK: I understand that the cash I have posted will be used to pay any fines, fees, or costs that the defendant owes if the court has ordered that the defendant may only be released upon the payment of such fines, fees, and costs and that if this is so I will not be entitled to a refund. If the court has not ordered that the defendant will only be released upon payment of fines, fees, and costs, [ ] I agree [ ] I do not agree that the cash I have posted may be used to pay any fines, fees, or costs that the court may order the defendant to pay after the defendant’s release from custody. _______________________________________ Signature of person posting cash (required) DEFENDANT: (If the defendant has been arrested on a failure to pay warrant, the defendant’s signature is not required.) (This alternative may be used only when the defendant has failed to appear, the bench warrant authorizes release on payment of fines and fees, and the person posting the cash has checked the “I agree” box above.) [ ] I plead guilty to the charges. I ask the court to use the cash for payment of fines, fees, and costs instead of requiring me to appear before the court. (This alternative may be used only when the bench warrant authorizes release of the defendant on bond, instead of payment of fines and fees.) [ ] I agree to appear in the ________________ court on _______________, _____ (date) at ________ [a.m.] [p.m.]. _______________________________________ Signature of defendant PAYMENT RECEIVED BY: _______________________________________ Signature of clerk or bail designee _______________________________________ Date COURT EMPLOYEE RECEIVING PAYMENT: _______________________________________ Signature of clerk or bail designee _______________________________________ Date