JS Form ALEA-HTSF  

Rev Jul.9.2018   

 

     

Monthly Remittance Form for the 
HIGHWAY TRAFFIC SAFETY FUND   
ACT 2014-222 and Act 2018-517 
 
For questions concerning the form contact Sherita Pace at 334-517-2944 
OR 
via email to Sherita.pace@alea.gov  

onthly report of court costs collected pursuant to ACT 2014/222, effective July 1, 2014, and Act 2018-

517, effective July 1, 2018, for the month of:  

 

 

, from the Municipal Court of  

 

 

 

 

 

 

Month                 

, 
  Year 

 

 

 

  $

 

 

 

 

 

 

  $

 

 

 

  $

Sub-Total 

Partial 
Payments 

Total 

Number 
Of 
Cases 

Disbursement 
On Each Case 
(for the first four 
(4) months only-  
on a per month 
basis) 
 
$15.00 

Number 
of Cases 
 

Disbursement 
On Each Case 
 
$60.00 

Sub-total 

Partial 
Payments 

Total 

 

 
Signature of Remitter and Title 

 

 

 

 

 
Print Name of Remitter 

 

 

 

 
Telephone Number 

 

 

 

 

 

 

 

Alabama Law Enforcement Agency (ALEA) 
Attn: Sherita Pace 
PO Box 304115 
Montgomery, AL 36130-4115 

 
 

 
 

 
 

 
 

 

   

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

DUI/Interlock (for defendants 
who own a vehicle and have 
the interlock device installed) 
Act 2014-222 cases prior to 
July 1, 2018  
 

DUI/Interlock (for convicted 
defendants who own a vehicle 
and have the interlock device 
installed) 
Act 2018-517 cases on or 
after July 1, 2018  

 

 

RAND TOTAL 

ate    
 

ourt ORI No.  
 
 

heck No.  

 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

he costs SHALL BE REMITTED by the 10th of each month.   

ake check payable to the HIGHWAY TRAFFIC SAFETY FUND.   

ail the original form along with remittance check to: 

      U

    M

   

     

    G

        D

 

  C

 

  C

 

  T

  M

  M