Form 295 - Fee Transmittal For State Of Michigan District Or Municipal Court Offices
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Michigan Department of Treasury
Collections are due by
295 (Rev. 11-11)
the 20th of the month.
Fee Transmittal for State of Michigan
District or Municipal Court Offices
Issued under authority of P.A. 71 of 1919 and the laws stated below.
INSTRUCTIONS: Use this form to transmit all fees to the Michigan Department of Treasury. You may no longer use Form 588 (formerly L-3215).
Follow the filing instructions at the bottom of the form. Send the original plus five (5) additional copies of the completed form.
Court Number, Name and Address
County
Reporting Period (month/year)
Account
Collections Due to the State Treasurer
Number
Amount
1.
1.
DO NOT USE
228.30
2.
2.
Department of State (FAC/FCJ Clearances) - MCL 257.321a
228.58
3.
3.
Civil Filing Fee Fund - MCL 600.171
228.42
4.
4.
State Court Fund - MCL 600.8371
228.59
5.
5.
Justice System Fund - MCL 600.181
6.
Juror Compensation Reimbursement Fund
228.57
6a.
Civil Jury Demand Fee - MCL 600.8371
228.57
6b.
Drivers License Clearance Fee - MCL 257.321a
228.37
7.
7.
Crime Victims Rights Fund - MCL 780.905
8.
Convicted Drunk Driver Assessment - MCL 769.1f
228.47
8a.
Reimbursement of Allowable Expenses Due State Police
228.48
8b.
Reimbursement of Allowable Expenses Due Department of Natural Resources
9.
Judgment Fee - Department of Natural Resources - MCL 324.1609, MCL 324.40119,
228.20
9.
MCL 324.48740
228.38
10.
10.
Children's Trust Fund - Playground Equipment - MCL 408.685
11.
11.
Total Collections Due to the State Treasurer. Add lines 1 through 10. Enter here
12. Report the total number of traffic civil infraction cases in the reporting period in which they become paid in
full - MCL 600.181. If an error is discovered in the total reported as fully collected in a prior month, adjust the
current reporting period total +/- and report the net total fully collected in the reporting period.
I certify that the fees reported and remitted were collected and are transmitted in compliance with the specified statutes.
Signature of Preparer
Preparer's Phone Number
Date
Print Name of Preparer
Title
Mail original form plus five (5) additional copies and a
Direct questions to:
check, payable to "State of Michigan", in the amount on
Treasury, Local Audit & Finance Division - (517) 373-3227
line 11 to:
State Court Administrator's Office - (517) 373-5596
Receipts Processing Division - Michigan Dept. of Treasury
Treasury, Receipts Processing Division - (517) 636-5386
P.O. Box 30788
Lansing, MI 48909-8288
An online fillable version of this form is available on the Internet at
(click on "Local Government" then "Forms/Instructions")
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