Form 73-334 - Request For County Reimbursement Of Indigent Inmate Representation
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273-334
STATE OF TEXAS
(Rev.2-08/2)
COMPTROLLER OF PUBLIC ACCOUNTS
REQUEST FOR COUNTY REIMBURSEMENT OF INDIGENT INMATE REPRESENTATION
OFFICE OF COURT ADMINISTRATION USE ONLY
AGY
COBJ
TC
FUND
AY
PCA
APPROVAL
DOCUMENT NUMBER
DOCUMENT AMOUNT
County name and address for warrant or direct deposit notification
County taxpayer identification number
Mail code
Mail completed form and documentation to:
COMPTROLLER'S JUDICIARY SECTION
P.O. Box 13528
Austin, TX 78711-3528
Call (800) 531-5441, ext. 6-5985 or (512) 936-5985
REQUIRED DOCUMENTATION
A copy of the Fee Schedule adopted by your county.
Enclosed
(If a current fee schedule is already on file with the Comptroller, it is not necessary to attach another one.)
Documentation that the court notified the board (TDCJ) that a defendant before the court is indigent and is an inmate
charged with an offense committed while in the custody of the correctional institutions division or a correction facility
Enclosed
operated by TDCJ.
Documentation that the court made a request to the board (TDCJ) to provide legal representation for the inmate before
Enclosed
court appointment of legal counsel for the inmate.
Description of specific conflict of interest.
Enclosed
Copy of the payment order signed by presiding judge and copy of attorney fee voucher submitted by each individual
attorney. Must include attorney’s name and a breakdown of hourly charges for in and out-of-court expenses totaling
Enclosed
amount paid by county.
$
TOTAL AMOUNT OF CLAIM SUPPORTED BY THE ATTACHED DOCUMENTATION
COURT CERTIFICATION
I, _________________________________________________________ , the authorized official, do hereby certify that the amounts
requested are due and payable pursuant to Article 26.051 of the Code of Criminal Procedure and the court has paid these expenses
which are to the best of my knowledge true and correct.
Authorized official
Date
COUNTY CONTACT INFORMATION
Person to contact regarding information on this form
Contact phone number (Area code and number)
Title
Contact e-mail address
COMPTROLLER APPROVAL
I approve this request for payment and to the best of my knowledge this request for payment is true and correct.
Direct deposit
This payment complies with Article 26.051 (i) of the Code of Criminal Procedure.
Check enclosed
Certified by
Date
SEE REVERSE SIDE FOR PROCEDURES AND FURTHER INSTRUCTIONS
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