Texas City and County Government Forms-40-136 Legal Services for Indigents and Supreme Court Support Fees Report

1. 40-136
b.
(Rev.4-08/6)
PRINT FORM CLEAR FIELDS
38280
a. T Code
LEGAL SERVICES FOR INDIGENTS AND SUPREME COURT SUPPORT FEES
Filed by the Supreme Court and Courts of Appeals
c. Identification number d. Report for quarter ending e. f. Due date of report
Court name and mailing address h. IMPORTANT
g.
Blacken this box if your address has 1
changed. Show changes by the
preprinted information.
j.
i.
Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you, with
limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error
correction, contact us at the address or toll-free number listed on this form.
REPORT MUST BE FILED EVEN IF NO PAYMENT IS DUE. DO NOT WRITE IN SHADED AREAS.
1. Filing Fee for Legal Services for Indigents
Government Code 51.941(a) - a $25 fee on the filing of any civil action or proceeding requiring a
$
filing fee, including an appeal, and on the filing of any counterclaim, cross action, intervention,
1.
interpleader or third-party action requiring a filing fee.
[To transmit revenue to the Comptroller (USAS) for Indigent Fees, use RTI #003704, Payee #39029029020-000.]
2. Supreme Court Support Fee
Government Code 51.0051(a) - an additional fee on the filing of any application or proceeding
otherwise requiring a filing fee, including an appeal. The additional fee is set by order or rule of the
$
Supreme Court in an amount necessary to defray costs and expenses incurred in the operation of
the court, not to exceed $50. (Currently set at $50) . 2.
[To transmit revenue to the Comptroller (USAS) for Supreme Court Support Fees, use RTI #003711, Payee #39029029020-000.]
$
3. Total amount of fees collected and remitted (Add Items 1 and 2.) 3.
[Payments should be made utilizing USAS - Recurring Transaction Index (RTI) method, as indicated.]
* * * DO NOT DETACH * * * DO NOT DETACH * * * DO NOT DETACH * * *
$
4. TOTAL AMOUNT OF PAYMENT (Same as Item 3) 4.
k. l.
Court name
T Code Identification no. Period For assistance call (800) 531-5441, ext. 3-4276, toll free nationwide.
The Austin number is (512) 463-4276.
38090
I, (type or print name) _____________________________________________ certify that the
information above is true as shown in the records of the Clerk of the Court named.
Authorized agent
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
Revenue Accounting Division
Title Date
P.O. Box 149361
Daytime phone (Area code and number)
Austin, Texas 78714-9361
40-136 (Rev.4-08/6)
444