Fillable Form 73-316 - Witness Fee Claim printable pdf download

State of Texas

73-316

(Rev.1-13/15)

Comptroller of Public Accounts

DOCUMENT NO

Witness Fee Claim

(CPA USE ONLY)

TEX. CODE CRIM. PROC. ANN. art. 35.27

AGY

PCA

COBJ

FUND

AMOUNT

APPROVED BY

(CPA USE ONLY)

241

00331

7224

0001

I ________________________________ , do certify that the below claim and accompanying certificate detailing expenses of the named witness is in my

PRINT JUDGE'S NAME

opinion correct, and all laws now in force relative to this claim have been complied with. I approve the claim subject to the approval of the State Comptroller.

I further certify that I have not allowed fees to more than one character witness summoned by the defendant when summoned under provisions of TEX. CODE

CRIM.PROC. ANN. Ch. 16 (1966). This case was set for trial on ____________________ and was continued until _______________________ .

DATE

RELEASED DATE

____________________________________________

_______ Judicial District of Texas OR County Judge of ____________________ County

JUDGE'S SIGNATURE

Witness name and mailing address (Please type)

Filed with the County/District Clerk on ____________________

DATE

__________________________________________________

CLERK SIGNATURE

Clerk of __________ District Court, ________________ County

Mail completed form to: COMPTROLLER JUDICIARY, P.O. Box 13528,

Austin, TX 78711-3528. Contact: (800) 531-5441, ext. 6-5985.

* * * PLEASE REFER TO THE BACK OF THIS FORM FOR THE APPROPRIATE MILEAGE RATES * * *

I _____________________________ , a witness in the below case, swear that in obedience to a

written request, or

subpoena, or

summons

WITNESS NAME

from

prosecuting attorney

court, which was received by me in __________________ County, I was in attendance in court. I

did

did not

furnish a personal automobile. I made _______round trips. Reimbursement requested at _______ cents per mile totals $ ____________________ .

Mileage claimed

(Print city, state)

(Print county)

(Print city, state)

(Print county)

MileS by

_________

FROM ______________________ in _______________County TO ___________________ in ______________County

highWAy

I further swear that the above statement is correct: the services were performed as stated: the miles charged have been actually traveled; and no part of

this claim has been paid except as shown. I was summoned as stated. I further swear that I am a bonafide resident of __________________ County, in

COUNTY NAME

__________________ . My residence there is permanent and I have not established a temporary residence in order to obtain mileage and per diem as a

STATE

witness. Witness social security number: ___________ - _________ - _____________ .

_______________________________________________________

WITNESS SIGNATURE

Subscribed and sworn to before me on ________________________

(seal)

DATE

_______________________________________________________

NOTARY SIGNATURE

Defendant

Case number

Type of case

Was this a change of venue?

MISDEMEANOR

FELONY

YES

WiTNeSS eXPeNSeS, (Please enter meals and lodging for each date. Additional dates can be entered on reverse.)

DAily eXPeNSeS FOR MeAlS AND lODgiNg

Total miles ___________@ ________ ¢ per mile .........

DATE

MEALS

LODGING

Parking total (Receipts required) ..................................

Taxi and or rental car total (Receipts required) .............

Bus, train, or air total (Receipts required) .....................

Meals total ......................................................................

Lodging total ..................................................................

TOTAlS

FROM AbOVe

gRAND TOTAl OF eXPeNSeS ClAiMeD .................

TOTAlS

FROM bACK

TOTAL AMOUNT DUE WITNESS .................................

gRAND TOTAlS

FOR MeAlS

TOTAL AMOUNT DUE COUNTY ...................................

AND lODgiNg

(SECTION BELOW MUST BE COMPLETED IF COUNTY IS DUE MONEY.)

I , ___________________________________________ , certify that ________________________ COUNTY IS DUE $ ______________________

WITNESS SIGNATURE

amount toward my expenses and request that those amounts be paid to them. County address __________________________________________ .

County vendor identification number ________________________________ .

County contact

Phone (Area code and number)

Form 73-316 - Witness Fee Claim

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