Form 40-128 - Excess Highway Fines
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1
240-128
PRINT FORM
CLEAR FORM
(Rev.9-11/11)
b.
32120
a. T Code
Excess Highway Fines
Do NOT write in shaded areas.
c. City/county identification number
e.
d. Report for quarter ending
If any information preprinted on
this form is incorrect, cross out
City/county name and mailing address
the incorrect information and
f.
write in the correct information.
h.
g.
This report must be filed when your city's/ county's fines and special expenses exceed 30 percent of your
city's/ county's revenue less federal funds and bond proceeds. This report should be filed in the quarter
following the month that the payment becomes due. Further instructions are on the reverse side.
City/county fiscal year begins (Month, year)
ends (Month, year)
1. Total revenue less federal funds and bond proceeds from previous fiscal year
(Taken from audit required by Local Government Code,
.
Chapter 103 - cities or Chapter 115 - counties)
1.
.
2. Multiply amount in Item 1 by .30 (30%)
2.
3. Enter the total amount of highway fines and special expenses collected this fiscal year
.
(See definitions and instructions for Item 3)
3.
.
4. Enter amount exceeded (Item 3 minus Item 2)
4.
5. Multiply the total number of convictions by $1.00 for all highway fines and
.
special expenses collected after the 30% cap is reached
5.
6. Excess highway fines and special expenses due the state
.
(Item 4 minus Item 5)
6.
7. Deduct the amounts on Items 5 and 8 from prior reports submitted this fiscal year.
.
Enter zero if this is the first report filed this year
7.
.
8. Excess highway fines and special expenses due this quarter (Item 6 minus Item 7)
8.
* * * DO NOT DETACH * * *
.
9. TOTAL AMOUNT DUE AND PAYABLE (Same as Item 8)
9.
j.
i.
City/county name
For assistance call (800) 531-5441, ext. 34276.
T Code
City/county identification no.
Period
The Austin number is (512) 463-4276.
32030
I, (type or print name) _________________________________________________________ certify
that the information above is true as shown in the records of the treasury of the city/county named.
Authorized agent
Complete this report and make the amount in Item 9
payable to: STATE COMPTROLLER
Our mailing address is: P.O. Box 149361
Title
Date
Austin, Texas 78714-9361
Phone number (Area code and number)
444
40-128 (Rev.9-11/11)
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