Form 73-281 - Witness Fee Claim (prior To September 1, 2001)

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STATE OF TEXAS
73-281
COMPTROLLER OF PUBLIC ACCOUNTS
(Rev.9-01/3)
DOCUMENT NO
WITNESS FEE CLAIM
(prior to September 1, 2001)
TEX. CODE CRIM. PROC. ANN. art. 35.27
AGY
PCA
AY
COBJ
FUND
AMOUNT
APPROVED BY
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, Texas 78711-3528. Contact: 1-800-531-5441, ext. 6-5985.
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 28 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
NO
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 _________ @ 28¢ 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)

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