Free Reimbursement form-1st Quarter 2009 - Arkansas

Report of Jury Expenditures and Request for Reimbursement of Jury Costs A.C.A. § 16-34-106 1st Quarter 2009 January 2009
*Payments to Persons Who Actually Serve as a Member of a Grand or Petit Jury at $50 per day Payments to Persons who are Summoned and Appear but do not Actually Serve as a Grand or Petit Juror at $15 per day or such higher amount as set by the county Payments of Mileage Reimbursement to Jurors, If Authorized by the County Other costs, such as meals, provided for or paid to Jurors TOTAL

February 2009

March 2009

TOTAL FOR QUARTER

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*Note that only these costs are eligible for reimbursement from the state. I hereby certify that this report reflects the true and accurate expenditures for jury costs for the time period indicated above. Signed this ________ day of ________________________, 200____. ________________________________________ Signature of Authorized County Official ___________________________________ Name of County

Return form by May 1, 2009 to the Administrative Office of the Courts, Attn: Joyce French, 625 Marshall Street, Little Rock, AR 72201