Total 

 
Partial 
Payments 

   

Sub-Total 

Number 
Of 
Cases 

Disbursement 
On 
Each 
Case 

 

 

 

  $

 

 

 

  $

 

 

 

  $

   

   

$2.33 

$5.00 

   

orm MC-21 

Rev. 7/2/2012   

 

     

Monthly Remittance Form for the 
CIRCUIT CLERKS’ JUDICIAL ADMINISTRATION FUND  
ACT 2012-535 
 

onthly report of court costs collected pursuant to ACT 2012-535, effective June 21, 2012, for the 

month of:  

Month                 

, 
  Year 

 

 

, from the Municipal Court of  

 

 

 

 

 

 

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

 

 
Signature of Remitter and Title 

 

 

 

 

 
Print Name of Remitter 

 

 

 

 
Telephone Number 

 

 

 

 

 

 

 

 

 

 

he costs SHALL BE REMITTED by the 10th of each month.  Make check payable to the CIRCUIT 

CLERKS’ JUDICIAL ADMINISTRATION FUND.  Keep a copy of this form for your records and mail the 
original form along with remittance check to: 

, Circuit Clerk 

 County 

 

 
Mailing Address                  City 

 

 

 

, AL 
 

 

 
Zip code 

 

 
 

 
 

 
 

 

 

 
 

       

 
 

 
 

 
 

 

 

 

 

 

 
 

 
 

 
 

 

 

Traffic Cases 

on-Traffic Misdemeanors/ 
Municipal Ordinance Violations 

RAND TOTAL 

ate    
 

ourt ORI No.  
 
 

heck No.  

 
 

 
 

 

 

 
 

 
 

 
 

 

 

 
 

 
 

 
 

 

 

 

 

 
 
 
 

      F

  M

   

     

    *

  N

    G

  *

      D

 

  C

 

  C

 

  T

   

   

 
 
 
 



Monthly Remittance Form for the Circuit Clerks' Judicial Admin Fund

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

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