Form 4147 - Fee Transmittal For State Of Michigan Local Corrections Officer Training Fund
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1
2Michigan Department of Treasury
4147 (Rev. 05-12)
Fee Transmittal for State of Michigan Local Corrections Officer Training Fund
Issued under authority of P.A. 124 of 2003.
Part 1: rePort information
County
Report Year
Report Period — Check the appropriate box
Jan/Feb/Mar — Due April 15
Mailing Address
Apr/May/Jun — Due July 15
Jul/Aug/Sep — Due October 15
City
State
ZIP Code
Oct/Nov/Dec — Due January 15
Part 2: Booking fee information
1. Report total number of bookings for the Report Period ............................................................................ 1.
$
2. Total State’s share of booking fees collected for the Report Period ......................................................... 2.
$
3. Total State’s share of booking fees refunded for the Report Period ......................................................... 3.
totaL State’S SHare of Booking feeS DUe tHe State of miCHigan. SUBtraCt Line
$
4.
...................................................................................................................................... 4.
3 from Line 2
Complete using the information of the form preparer.
Part 3: PreParer CertifiCation —
I certify that the fees reported and remitted were collected and are transmitted in compliance with the specified statutes.
Preparer’s Name
Title
Signature
Date
E-Mail Address
Telephone Number
Fax Number
If an amount is due on line 4, make a check payable to “State of michigan,” and indicate “LCot” on the front of check.
Do not staple check to form.
Mail this original transmittal form and payment, if applicable, to:
Michigan Department of Treasury
Receipts Processing Division
PO Box 30788
Lansing MI 48909-8288
If you have any questions, contact the Michigan Sheriffs’ Coordinating and Training Council by phone at (517) 999-7282
or by fax at (517) 999-0121.
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