Fillable Form 40-139 - Sexual Assault / Substance Abuse Programs printable pdf download

Please complete and sign this report and enter

CLEAR FIELDS

PRINT FORM

40-139

a telephone number that can be called if

(Rev.4-08/3)

additional information is necessary.

32670

a. T Code

SEXUAL ASSAULT / SUBSTANCE ABUSE PROGRAMS

DO NOT WRITE IN SHADED AREAS.

c. County identification number

d. Report for quarter ending

f. Due date of report

County name and mailing address

IMPORTANT

Blacken this box if your address

has changed. Show changes by

the preprinted information.

SEXUAL ASSAULT PROGRAM FUND

(Code of Criminal Procedure Art. 42.12, Sec. 19(e))

If the court grants probation to a person convicted of an offense under Sections 21.08, 21.11. 22.021, 25.02, 25.06, 43.25 or 43.26 of the Penal

Code, the court shall require as a condition of probation that the person pay to the supervising probation officer a fee of $5 each month during the

period of probation. This fee is in addition to court cost or any other fee imposed on the person. A court clerk or a community supervision

department shall deposit the fees collected under Subsection (e) to be sent to the Comptroller no later than the last day of the month following a

calendar quarter. The Comptroller shall deposit these funds in the Sexual Assault Program Fund under Section 420.008 of the Government Code.

Use supplement pages to list all fees collected. Enter the total number of supplement pages included on line 1, and the total amount of fees due on

all supplement pages on line 2.

1. Number of Supplement pages (for Sexual Assualt Program fees)

2. Total Fees Collected For Sexual Assault Program

SUBSTANCE ABUSE FELONY PROGRAM --Residential Aftercare Program

(Code of Criminal Procedure Art. 42.12, Sec. 14)

If a judge requires as a condition of community service that the defendant serve a term of confinement and treatment in a substance abuse

treatment facility under this section, the judge shall also require as a condition of community supervision that on release from the facility the

defendant:

(1) participate in a drug or alcohol abuse continuum of care treatment plan; and

(2) pay a fee in an amount established by the judge for residential aftercare required as part of the treatment plan.

A court clerk or a community supervision department shall deposit the payments made by defendants required to pay residential aftercare fees

(under Subsection (c) (2)), to be sent to the Comptroller no later than the last day of the month following a calendar quarter.

Use supplement pages to list all fees collected. Enter the total number of supplement pages included on line 3, and the total amount of fees due on

all supplement pages on line 4.

3. Number of Supplement pages (for Substance Abuse Felony Program fees)

4. Total Fees Collected for Substance Abuse Felony Program

5. TOTAL FEES DUE FOR THIS PERIOD (Total of Item 2 and Item 4)

* * * DO NOT DETACH * * * DO NOT DETACH * * * DO NOT DETACH * * *

6. TOTAL AMOUNT DUE AND PAYABLE

(Same as Item 5)

County name

T Code

County identification no.

Period

For assistance call (800) 531-5441, ext. 3-4276, toll free nationwide.

The Austin number is (512) 463-4276.

32660

I, (type or print name) _____________________________________________ certify that the

information above is true as shown in the records of the Treasury of the county named.

Authorized agent

Complete this report and make the amount in Item 6 payable to:

STATE COMPTROLLER

Mail to: COMPTROLLER OF PUBLIC ACCOUNTS

Title

Date

P.O. Box 149361

Austin, Texas 78714-9361

Daytime phone (Area code and number)

40-139 (Rev.4-08/3)

444

Form 40-139 - Sexual Assault / Substance Abuse Programs

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