Form 40-14 - State Criminal Costs And Fees
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1
240-145
Please complete and sign this report and enter a telephone
(Rev.9-09/5)
PRINT FORM
CLEAR FIELDS
number that can be called if additional information is necessary.
32630
b.
a. T Code
State Criminal Costs and Fees
DO NOT WRITE IN SHADED AREAS
COUNTY QUARTERLY REPORT - This report must be filed by the due date even if no payment is due.
An amount or a zero (0) MUST be entered on all lines for Columns 1 and 3.
c. County identification number
e. Due date of report
f. Report for quarter ending
g.
QUARTER ENDING
County name and mailing address
h. IMPORTANT
d.
Blacken this box if your address has
changed. Show changes by the
1
preprinted information.
i.
j.
Column 1
Column 2
Column 3
SEE BACK FOR INSTRUCTIONS
TOTAL COLLECTED
SERVICE FEE
AMOUNT DUE STATE
(State court costs only)
(See instructions)
(Col. 1 minus Col. 2)
Dollars and cents
$
$
1. 01-01-04 Forward
1.
2. 09-01-01 --- 12-31-03
2.
3. 08-31-99 --- 08-31-01
3.
4. 09-01-97 --- 08-30-99
4.
5. 09-01-91 --- 08-31-97
5.
6. Bail Bond Fee (BB)
6.
7. DNA Testing Fee - Convictions (DNA)
7.
8. DNA Testing Fee - Comm Supvn (DNA CS)
8.
9. DNA Testing Fee - Juvenile (DNA JV)
Not applicable
9.
10. EMS Trauma Fund (EMS)
10.
11. Juvenile Probation Diversion Fee (JPD)
11.
12. Jury Reimbursement Fee (JRF)
12.
13. Indigent Defense Fund (IDF)
13.
14. Moving Violation Fees (MVF)
14.
15. State Traffic Fine (STF)
15.
(5%)
$
16. Peace Officer Fees (Report 20% of fees from actions by state officers only.)
16.
17. Failure to Appear/Pay Fees (FTA) (Report $20 of the administrative fee.)
17.
18. Judicial Fund - Constitutional County Court
18.
19. Judicial Fund - Statutory County Court
19.
20. Motor Carrier Weight Violations (MCW) (Report 50% of the fines collected.)
20.
21. Time Payment Fees (TP) (Report 50% of the $25 fee.)
21.
22. Driving Records Fee (DRF) (Report 100% of fees collected.)
22.
23. Judicial Support Fee (JS)
23.
$
24. TOTAL DUE FOR THIS PERIOD (Total of Items 1 thru 23 in Column 3.)
24.
* * * DO NOT DETACH * * *
25. TOTAL AMOUNT DUE AND PAYABLE (Same as Item 24)
25.
$
County name
k.
l.
For assistance, call (800) 531-5441, ext. 3-4276, or (512) 463-4276.
T Code
County identification no.
Period
I, (type or print name) _________________________________________________________ certify
32620
that the information above is true as shown in the records of the treasury of the county named.
Make the amount in Item 25 payable to:
STATE COMPTROLLER
Title
Date
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
P.O. Box 149361
Phone number
Austin, TX 78714-9361
(Area code and number)
444
40-145 (Rev.9-09/5)
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Parent category: Financial