County reimbursement form 2026

1. Click ‘Get Form’ to open the county reimbursement form in the editor.
2. Begin by entering your county name, address, and taxpayer identification number in the designated fields at the top of the form.
3. In the JUROR PAYMENT REIMBURSEMENT REQUEST section, select the appropriate quarter and enter the amount you are claiming in the 'Amount Requested' column.
4. Complete the County Certification section by providing your name, title, and date. Ensure that an authorized official certifies this request.
5. Fill out the County Contact Information section with a contact person’s name, email, and phone number for any inquiries regarding this form.
6. If using supporting documentation, circle the relevant quarter on that sheet and fill in all required details accurately. Ensure totals match your claim.
7. Review all entries for accuracy before submitting. Mail your completed form to the Comptroller’s Judiciary Section by the due date indicated.

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