Form 40-125 - State Court Costs And Arrest Fees - State Comptroller - Texas
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1Please complete and sign this report and enter
40-126
a telephone number that can be called if
(Rev.7-03/11)
b.
additional information is necessary.
32100
a. T Code
DO NOT WRITE IN SHADED AREAS
STATE COURT COSTS AND ARREST FEES
CITY QUARTERLY REPORT - (This report must be filed by the due date even if no payment is due.)
c. City identification number
g.
e. Due date of report
f. Report for quarter ending
City name and mailing address
IMPORTANT
h.
d.
Blacken this box if your address
has changed. Show changes by
1
the preprinted information.
j.
i.
Column 1
Column 2
Column 3
DESCRIPTION
TOTAL COLLECTED
SERVICE FEE
AMOUNT DUE STATE
SEE BACK FOR INSTRUCTIONS
PART I
$
$
1. Peace Officer Fees
1.
2. Correctional Management Institute (CMI)
2.
3. Failure to Appear/Pay fee (FTA)
3.
4. State Traffic Fee (STF)
4.
PART II - For offenses PRIOR to September 1, 1997 ONLY.
$
$
5. Court costs for offenses 9-01-91 through 8-29-93
5.
6. Court costs for offenses 8-30-93 through 8-31-95
6.
7. Court costs for offenses 9-01-95 through 8-31-97
7.
PART III - For offenses committed ON or AFTER September 1, 1997 ONLY.
$
$
8. Compensation to Victims of Crime (CVC)
8.
9.
9. Consolidated Court Costs (CCC)
10. Fugitive Apprehension (FA)
10.
11. Judicial and Court Personnel Training (JCPT)
11.
12. Juvenile Crime and Delinquency (JCD)
12.
13. TOTAL DUE FOR THIS PERIOD
13.
(Total of Items 1-12 in Column 3)
* * * DO NOT DETACH * * * DO NOT DETACH * * * DO NOT DETACH * * *
14. TOTAL AMOUNT DUE AND PAYABLE
14.
(Same as Item 13)
City name
k.
l.
For assistance call 1-800-531-5441, Ext. 3-4276, toll free nationwide, or call 512/463-4276.
City identification no.
Period
T Code
(From a Telecommunications Device for the Deaf (TDD), call 1-800-248-4099 toll free,
or call 512/463-4621.)
32020
I, (type or print name) _________________________________________________________ certify
that the information above is true as shown in the records of the treasury of the city named.
Complete this report and make the amount in Item 14 payable to:
Authorized agent
STATE COMPTROLLER
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
Date
Title
111 E. 17th Street
Phone number (Area code and number)
Austin, Texas 78774-0100
222 A
40-126 (Rev.7-03/11)
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