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Attachment A Form. This is a Oklahoma form and can be use in District Court Statewide.
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Tags: Attachment A, Oklahoma Statewide, District Court
IN THE DISTRICT COURT OF ______________________ COUNTY
STATE OF OKLAHOMA
STATE OF OKLAHOMA
Plaintiff,
- vs ____________________________________________
Defendant,
(DOB: _______________________________________)
)
)
)
)
)
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CASE NUMBER
A TTACHMENT A
The Defendant, _____________________________________________, is ordered by the attached
Judgment and Sentence to repay the Court Fund of ____________________________ County the following dollar
amounts representing fines, costs and assessments resulting from his/her conviction. Monies collected shall be
applied to the balance due in the order of priority listed on this Attachment. All fines, costs and assessments are due
and owing from the date of Sentencing and must be paid in full by _______________________________ or the
Defendant must reappear in this Court for further proceedings. Costs, such as appellate proceedings and
transportation costs, may continue to accrue after judgment and sentence. Additional costs may be certified by the
Court Clerk as they accrue.
Schedule of Reimbursement
1.
Court Costs
2.
Fines
3.
Attorney Fees
4.
CLEET
5.
OSBI Lab Fees
6.
County Sheriff
7.
Victim’s Compensation
8.
Restitution
9.
Drug Abuse Education and Treatment Fund
__________________________________________________
__________________________________________________
TOTAL
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
$_______________________________
=============================
_____________________________________________
Judge of the District Court
I certify that the foregoing figures are true and accurate to the best of my knowledge.
_____________________________________________
Clerk/Deputy
Date: ____________________________
Attachment A
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