1700 West Washington, Phoenix, Arizona 85007-2812

ARIZONA STATE TREASURER’S OFFICE

1700 West Washington, Phoenix, Arizona 85007-2812

(602) 604-7800 FAX: (602) 542-7176

STATE REMITTANCE REPORT

Report Period:______Prepared By: ______

Date: ______/______/______Title: ______

Depositor Code #______Phone #: ______

Depositor Name: ______

Address: ______negative amounts are not to be used on this form

______(contact this Office for guidance regarding negative entries)

DESCRIPTIONSTATUTE (ARS #) AMOUNTDESCRIPTION STATUTE (ARS #) AMOUNT

FINES & FEESFINES & FEES (continued)

Confidential Inter Fund 08-135; 12-284.03A8______Dept of Law – Crim. Cases41-2421E4______Juvenile Family Counseling 08-263C ______

Victim’s Rights – Juvenile08-418; 41-191.08______DUI, OUI Assessment5-395.01; 5-396, 7;28-1381-3;

AHCCCS11-292______(public safety equip fund)28-8284, 6-8; ______JCEF-Filing Fees 12-284.03A7; 22-281C1; FARE General Services Fee ______

22-404C1______FARE Delinquent Fee______JCEF-Time Payment 12-116B ______FARE Special Collections Fee ______JCEF – Diversion Fee 12-114 ______FARE Installment Fee ______

JCEF- Probation Assessment 12-114.01Constable Ethics Fund11-445 (80%)

DNA Penalty Assessment 12-116.01C, JConstable Ethics Fund11-445 (20%)

2011 Add’l Assmnt(**see below)12-116.04CGITEM41-1724/ 11-1051

(**State Treas use only)______OTHER FINES & FEES (describe and indicate ARS#)

50% GITEM 50% PSEF______

Confidential Address Fund12-116.05______

Domestic Violence12-116.06, 12-284.03A2______

Drug Prevention Res Center12-284.03; 41-2402H______TAXES

Child Abuse12-284.03A3 ______Prior Year Real Property42-208______

Sex Offender Assessment13-3821, 3824______Personal Property42-208______

Anti-Racketeering Fund13-811B; 13-2314.01______County Education District15-991.01A______

Drug & Gang Enforce Acct13-811C; 41-2402______Property-Min School Tax15-992B, C______

Community PunishmentState Water Banking48-3715.03; 45-2425______

Program Drug Fines13-821; 12-299 ______C.A.W.C.D. 48-3715______

Technical Registration Bd12-116.08; 13-3423 ______Groundwater Replenishment48-3773.A3; 48-3772______

Citizens Clean Election Fund16-949D; 16-954C ______Annual Membership Dues48-3779______

Game & Fish - Wildlife 17-313A______OTHER TAXES (describe and indicate ARS#)

AZ Lengthy Trial Fund21-222______

Alternative Dispute 22-281C2; 12-135;______

Resolution Fund 12-284.03A5 ______

Mining Fees27-208D______90/10 REVENUE

Child Passenger Restraint28-907C______Mobile Home Relocation33-1476.03 (90%)______

DPS – Civil Penalty 28-4139C______Mobile Home/Ins. & Cost33-1476.03 (10%)______

DUI Abatement Fund28-1304; 28-1382, 3 ______

General Fund/(includes28-737; 28-876; 28-2416;

Civil Penalties)32-1166, 44-1799.81,TOTAL AMOUNT REMITTED:

41-1722______

AZ Highway Fines (HURF)28-5438F; 28-2533C______By Check______

Victim Comp/Assistance31-411F; 31-466B______By Cr Advice (Wire) ______

Registrar of Contractors32-1107; 32-1124______

MSEF Penalty Assessment36-2219.01; 12-116.02F______ TOTAL______

CJEF Penalty Assessment 41-2401; 12-116.01______

Arson Detection Reward Fund 41-2167______

FTG Penalty Assessment 7% 41-2421J; 12-116.01B______FOR STATE TREASURER USE ONLY

Prison Const & Ops Fund 41-1651; 5-395.01A4 ______

NOTES:

Certain funds are required to be remitted to the State Treasurer directly, while others are to be remitted to other entities; i.e., county treasurer, city treasurer, etc. Only use this form to remit funds to the Arizona State Treasurer as required by Arizona Revised Statutes (A.R.S.). For all other remittances, please check with your city or county. Form TRE 102A is to be used by counties for required detailed information. Pleasekeep a copy of this report for your records.

TRE 101A (Rev. 10/12)