Rd - 1081 - Remittance Report Template
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1THE STATE CHILDREN'S TRUST FUND
RD - 1081
REMITTANCE REPORT
MAIL TO:
FROM:
GEORGIA DEPARTMENT OF REVENUE
ACCOUNT NO.
P.O. BOX 116924
P-________________
PROBATE COURT
ATLANTA, GA 30368
S-________________
SUPERIOR COURT
This report represents fees on the following
categories for the month of
County______________________________________
____________________________________________
____________________________________________
Phone_______________________________________
Number of
Computation of
Licenses / Cases
amount due
Amount Due
Judge of the Probate
Court Only
Marriage Licenses Issued
No. of licenses X $15.00
Clerk of the Superior
Court Only
Divorce Cases Filed
No. of cases X $5.00
To the best of my knowledge and belief this is the correct amount for the period stated above which
is due the Georgia Department of Revenue pursuant to the Child Abuse and Neglect Prevention Act.
Signature of individual filing report
Title
Date
Make all remittances payable to the
GEORGIA DEPARTMENT OF REVENUE
Check No.
Check Amount
FILING PROVISIONS
The 1987 Georgia General Assembly enacted Legislation (Act 740 Ga. Laws 1987 P. 1133) to
provide an additional fee of $5.00 for all divorce cases filed and $15.00 for all marriage licenses
issued. The Report of these additional fees MUST be filed by the last day of the month following
the month of collection, otherwise the Act provides for a penalty of 5 percent per month not to
exceed 25 percent of the principal amount due.
ALL INQUIRIES SHOULD BE DIRECTED TO:
GEORGIA DEPARTMENT OF REVENUE
CENTRAL ACCOUNTING SECTION
(404)417-2222
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