Form 73-279 7/7/3 - Comptroller Judiciary Apportionment Voucher - State Of Texas
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1
2STATE OF TEXAS
73-279
(Rev.7-07/3)
COMPTROLLER JUDICIARY APPORTIONMENT VOUCHER
DOCUMENT AMOUNT
DOCUMENT NUMBER
Position title
AGY
COBJ
TC
FUND
AY
PCA
241 7622 225 0001
•
•
Texas identification number
DO NOT WRITE IN SHADED AREAS
Payee name / address for warrant or direct deposit notification (Please type)
Dates covered on this voucher
From:
To:
Mail completed form to: COMPTROLLER JUDICIARY
P.O. Box 13528
Austin, TX 78711-3528
One-third of annual amount becomes available in September, January, and May.
Contact Judiciary Staff at: (800) 531-5441, ext. 6-5985
The state fiscal year runs from September through August.
EMPLOYEE NAME
POSITION TITLE
AMOUNT FOR DATES COVERED
TOTAL SALARIES FROM REVERSE SIDE OR ADDITIONAL PAGES
OFFICE EXPENSES (Please specify, i.e., rent, utilities, office supplies, lease of computers, copiers, etc.)
TOTAL OFFICE EXPENSES (from reverse side)
You have certain rights under Chapters 552 and 559, Government
TOTAL TRAVEL FOR STAFF (from reverse side)
Code, to review, request, and correct information we have on file about
you. Contact us at the address or toll-free number listed on this form.
GRAND TOTAL FOR
DATES COVERED
CERTIFICATION
I, ___________________________________________ , hereby certify that I am the
(Complete appropriate blank.)
PRINT NAME
District Attorney of the ________________________ Judicial District or the
County Attorney of ________________________ County or the
Criminal District Attorney of ________________________ County
I further certify that the account is true, correct and unpaid.
Date
Person to contact regarding information on this form
Contact phone number
Contact e-mail address
I approve this voucher for payment. The above goods or service corrrespond in every particular with the contract under which they were purchased. The
invoice for the goods or services is correct. This payment complies with the General Appropriation Act.
Date
AUDITED BY:
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