CC Resolution 2018-044 Indigent Status for Parking Citations RESOLUTION NO. 2018 - 044
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF LA QUINTA, CALIFORNIA, ADOPTING A
POLICY ESTABLISHING THE PROCEDURES AND
CRITERIA FOR INDIGENT STATUS
DETERMINATION AS IT PERTAINS TO PERSONS
SEEKING PAYMENT PLAN OPTION FOR
PARKING VIOLATIONS, PURSUANT TO
ASSEMBLY BILL 503 (LAKEY)
WHEREAS, pursuant to Assembly Bill No. 503 (Lakey), approved by
Governor Brown on October 13, 2017, public agencies shall adopt a written
procedure to allow a person who is indigent to request a payment plan for
parking citation amount due upon satisfactory proof of an inability to pay the
amount due; and
WHEREAS, this policy sets forth the procedures and criteria for the
City of La Quinta (“City”) or its designee to make a determination on the
indigent status of persons seeking payment plan option for parking
violations; and
WHEREAS, a person may allege to be indigent and request payment
plan option for parking citation amount due, due to inability to pay; and
WHEREAS, a person may request an administrative hearing without
advance payment of parking citation amount due if he/she has been
determined to be indigent; and
WHEREAS, each person shall submit to the City or its designee an
application requesting that a determination be made as to his/her indigent
status, an affidavit of financial worth, and a release form authorizing the City
or its designee to obtain his/her most recent income tax return.
WHEREAS, the City will post this policy on the City’s website.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City
of La Quinta, California, as follows:
SECTION 1. That the City Council adopts this policy establishing
procedures and criteria for indigent status determination as it pertains to
persons seeking payment plan option for parking violations, pursuant to
Assembly Bill No. 503 (Lakey).
CITY OF LA QUINTA
Code Compliance
78-495 Calle Tampico, La Quinta, CA 92253 Phone: 760-777-7050
APPLICATION FOR PAYMENT PLAN OPTION OF PARKING CITATION
Name: ___________________________ Phone #: ___________________________ Email: ________________________________
Address: __________________________ City: ___________________________ State: _______________ Zip: _______________
Citation(s) #: _______________________________ License Plate: _______________________ DL #: _______________________
AB 503 - UNPAID PARKING CITATION PAYMENT PLAN
As set forth in CVC 40220, effective July 1, 2018, the City of La Quinta will allow Payment Plan options for Registered
Owner(s)/Lessee(s) with unpaid parking ticket(s) who can provide proof of indigency.
Please indicate the documentation you have attached to this application:
(A)Proof of income. Please provide your three (3) most recent pay stubs.
A.1. My monthly income amount is:
A.2. Number of people residing in the household:
(B)Must provide Verification of Benefits Form for Public Assistance or Award Letter for Social Security.
Please check applicable boxes:
[ ] Employment [ ] Supplemental Security Income (SSI)
[ ] In-home Supportive Services (IHSS) [ ] Medi-Cal
[ ] Food Stamps [ ] California Work Opportunity (Cal Works)
[ ] General Relief (GR), County Relief or [ ] Other
General Assistance (GA)
(C)If the Registered Owner(s)/Lessee(s) does not have income or receives public assistance, a copy of annual earnings
from the Social Security Department is required.
I certify that all statements are true and correct. Any false or incomple te information may forfeit my rights to a Payment Plan.
Signature: ____________________________________________________ Date: ________________________________________
Please return this form along with your supporting documents to:
City of La Quinta
Code Compliance
78-495 Calle Tampico
La Quinta, CA 92253
Department Use Only
Payment Plan: [ ] Indigent Approval: [ ] Granted [ ] Denied
Signature: Date:
EXHIBIT A
RESOLUTION NO. 2018-044
APPLICATION FOR INDIGENT PAYMENT PLAN
NOTICE TO APPLICANT
City staff or designee will review and make a final determination of your eligibility as an indigent as soon as possible
after submittal of this form.
If it is determined that you are not indigent, you will be notified of this finding. Within three days of notification,
excluding Saturdays, Sundays, and state holidays, you must either withdraw your statement or pay the parking citation
amount due.
PLEASE PRINT LEGIBLY
I,state that I am unable to pay
the parking citation due in the amount of $ , citation number:
I further swear or affirm that the responses which I have made to the questions and instructions below relating to my ability to
pay said cost are true.
PERSONAL INFORMATION
NAME: HOME PHONE SOCIAL SECURITY #
STREET ADDRESS WORK PHONE VETERANS ADMIN. #
CITY STATE ZIP MESSAGE WELFARE #
TOTAL DEPENDENTS: ATTACH ADDITIONAL SHEET IF
NEEDED
OCCUPATION:
NAME AGE EMPLOYER
ADDRESS STREET ADDRESS
NAME AGE CITY STATE ZIP
ADDRESS LENGTH OF EMPLOYMENT (If under 10 years, attach additional employment history)
NAME AGE MONTHLY GROSS INCOME: (Please attach copy of most recent pay stub)
ADDRESS TOTAL MONTHLY INCOME OF DEPENDENTS (Excluding spouse):
SPOUSAL INFORMATION
NAME SOCIAL SECURITY # HOME PHONE
STREET ADDRESS (If different) WORK PHONE MESSAGE
CITY STATE ZIP MONTHLY GROSS INCOME:
OCCUPATION:
EMPLOYER
STREET ADDRESS
CITY STATE ZIP
RESOLUTION NO. 2018-044 EXHIBIT B
AFFIDAVIT OF FINANCIAL WORTH IN SUPPORT OF
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OTHER MONTHLY INCOME
a. Unemployment & Disability $ g. Income Property $
b. Social Security $ h. Personal Loans $
c.Welfare, AFDC $ I. Employment Bonus $
d. Veteran’s Benefits $ J. Other (Specify)
e. Spousal Support Payments $
f. Child Support Payments $ **
** If you are receiving any child support from any other person, complete the following:
NAME OF PERSON PAYING SUPPORT AMOUNT OF SUPPORT RECEIVED:
INDICATE WHETHER SUCH SUPPORT IS RECEIVED: DIRECT THROUGH A PROBATION DEPARTMENT FROM A COURT
MONTHLY EXPENSES
a. Rent or House Payment (Circle One) $g. Food $
b. Car Payments $ h. Utilities $
c. Medical & Dental Payments $ I. Clothing $
d. Loan Payments $ J. Transportation $
e. Support Payments $
K. Other expenses (Please
Specify) $
f. Insurance $
INSTALLMENT PAYMENTS, OTHER THAN LISTED ABOVE
NAME OF CREDITOR (Attach sheet for additional creditors.) MONTHLY PAYMENT BALANCED OWED
a. $ $
b. $ $
c. $ $
ASSETS
WHAT DO YOU OWN? (Attach additional sheet if necessary) VALUE
a. Cash $
b. House Equity $
c. Cars, Other Vehicles & Boat Equity (List make, year & license number of each)$
d. Checking, Savings & Credit Union Accounts (Lists names of each)$
e. Other Real Estate Equity $
f. Income Tax Refunds Due $
g. Other Personal Property (jewelry, furniture, furs, stocks & bonds, etc.)$
h. Other assets (IRA’s stock/bonds, trust, etc.)$
TOTAL $
I declare under penalty of perjury that this statement (including any accompanying schedules and statements) has
been examined by me and to the best of my knowledge and belief is true, correct and complete.
DATE:
(SIGNATURE)
REMARKS:
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