Fillable Form 73-325 - Visiting Judge'S Salary Claim printable pdf download

Form 73-325 - Visiting Judge'S Salary Claim

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73-325

(Rev.8-05/2)

VISITING JUDGE’S SALARY CLAIM

Check one box

COMPTROLLER JUDICIARY

1-800-531-5441

Former District/Appellate

Former County Judge

P.O Box 13528

Ext 6-5985

Retired District/Appellate

Retired County Judge

Austin, TX 78711

I, ____________________________________________ certify that I was assigned to preside over the following Courts

of Texas, listed below, by the Honorable ____________________________________________ , presiding judge of the

________ Administrative Region / Chief Justice of the Supreme Court and did so preside for

______

days as follows:

FULL DAYS

HALF DAYS

DATE

*COURT

DATE

*COURT

DATE

*COURT

DATE

*COURT

* For District Court, use DC & Court # / For Court of Appeals, use COA & Court # / For Criminal District Court, use CDC & Court # plus for Tarrant county use “T”, for Dallas

county use “D” and for Jefferson county use “J”.

I hereby certify that this claim has been examined by me and to the best of my knowledge and belief is correct and unpaid.

Signature of assigned judge

Date

Address

Social Security number

City, state, ZIP code

* Disclosure of your social security number is required and authorized under law

for tax administration and identification of any individual affected by the law.

42U.S.C. §405 ( c ) (2) ( C )(i); Tex. Gov’t. Code §§403.011, 403015, and 403.078.

Daytime phone (Area code and number)

Release of information in response to a public information request will be