Form 40-141 - Civil Fees Quarterly Report
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1
240-141
PRINT FORM
CLEAR FORM
b.
(Rev.10-09/6)
32650
a. T Code
Civil Fees
DO NOT WRITE IN SHADED AREAS
- QUARTERLY REPORT
c. City / County identification number
e. Due date of report
f. Report for quarter ending
g.
QUARTER ENDING
City / County name and mailing address
IMPORTANT
h.
d.
Blacken this box if your address
has changed. Show changes by
1
the preprinted information.
j.
i.
DESCRIPTION
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
Number (#) issued/filed
TOTAL COLLECTED
5% SERVICE FEE
AMOUNT DUE
SEE BACK FOR INSTRUCTIONS
#
$
1. Birth Certificate Fees
1.
$
2. Marriage License Fees
2.
3. Declaration of Informal Marriage
3.
4. Nondisclosure Fees
4.
5. Juror Donations
5.
Filing Fees
6. Justice
Indigents Legal Services
6.
Courts
7. Statutory
7a. Filing Fee
7a.
Probate
Indigents Legal Services
Court
7b. Judicial Fund
7b.
Filing Fees
8a. Filing Fee
8. Statutory
Indigents Legal Services
8a.
County
Court
8b. Judicial Fund
8b.
Filing Fees
9a. Filing Fee
9. Constitutional
9a.
Indigents Legal Services
County
Court
9b. Judicial Fund
9b.
Filing Fees
10a. Divorce & Family Law cases
#
$
$
$
(Col. 3 is $0.25 times Col. 1)
10a.
10. District
10b. Other than Divorce/Family Law
Court
#
$
$
$
10b.
(Col. 3 is $0.50 times Col. 1)
10c. Indigents Legal Services
#
$
$
$
(Sec.133.152)
10c.
#
$
$
11. Judicial Support Fee
11.
$
12. TOTAL DUE FOR THIS PERIOD (Total of all Items in Column 4)
12.
* * * DO NOT DETACH * * * DO NOT DETACH * * * DO NOT DETACH * * *
$
13. TOTAL AMOUNT DUE AND PAYABLE (Same as Item 12)
13.
City/County name
k.
l.
For assistance call (800) 531-5441, ext. 3-4276, or (512) 463-4276.
T Code
City/County identification no.
Period
I, (type or print name) _________________________________________________________ certify
32640
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 13 payable to:
STATE COMPTROLLER
Date
Title
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
Phone number
P.O. Box 149361
(Area code and number)
Austin, Texas 78714-9361
444
40-141 (Rev.10-09/6)
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