$

 

 

 

   

Total 

 
Partial 
Payments 

   

Sub-Total 

No. 
Of 
Cases 

APOABF 
Deduction 
Each Case 
 

$5.00 

 

 

 

 

 

 

 

 

 

 

 

 

 

$3.00 

$7.00 

$3.00 

$7.00 

   

 

 

 

 

 

Traffic Violations 

Traffic Violations Prior to June 21, 2012 
Non-traffic Misdemeanors and/or 
Violations of City Ordinances 
*Bond Forfeitures 
           (Traffic Violations) 
**Bond Forfeitures 
           (Non-Traffic Violations) 
 

GRAND TOTAL 

   

Type of Case 

 
Month   
 

Form APO-1 
Rev 6/11/2012 

Monthly Remittance Form for the 
ALABAMA PEACE OFFICERS’ ANNUITY AND BENEFIT FUND 
514 South McDonough Street 
PO Box 2186 
Montgomery, AL 36102-2186 

TO THE EXECUTIVE DIRECTOR:  Monthly report of court costs and/or forfeitures collected for the 
Alabama Peace Officers’ Annuity and Benefit Fund for the month of: 

, 
  Year 

, for the Municipal Court of    

 

 

 

 
*Does not apply to “parking”, “seat belt” and “open container” violations. 

 

*Only applies when bond forfeiture results in a final disposition of the case. 

o the best of my knowledge and ability, this is the amount for the period stated above due the Alabama 

Peace Officers’ Annuity and Benefit Fund as required by Act No. 1210, effective September 17, 1971, 
amended by Act No. 91-438 (§36-21-67), effective July 17, 1991, and Act No. 2012-535, effective June 
21, 2012.   

 
 

 
 

 
 

 
 

 
 

 
 

 
 
Signature of Remitter and Title 

 

 

 

 
 
Print Name of Remitter 

 

 

 
Telephone Number 

 

 

 

 

 

ate  

ourt ORI  

heck Number  
 
 

 
 

 

 
 
 
 

 
 

 
 

 
 

 
 
 
 

ccording to §36-21-67 et seq., Ala. Code 1975, the costs SHALL BE REMITTED by the 10TH of each 

month succeeding that in which the cost is paid.   

ake check payable to the ALABAMA PEACE OFFICERS’ ANNUITY AND BENEFIT FUND.  Keep a copy of 

this form for your records and mail the original form along with the check to: 

John E. Hixon, Jr., Executive Director 
Alabama Peace Officers’ Annuity and Benefit Fund 
PO Box 2186 
Montgomery, AL 36102-2186  

 

 
 

 
 

 
 

 
 

 
 
 
 

 
 

 
 

 
 

 
 
 
 

   

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