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

Essential components of a mileage reimbursement form Your full name and employee ID (if applicable) Vehicle information (make, model, year) Business purpose for each trip. Date and time of travel. Starting and ending odometer readings. Total miles driven. Any additional expenses like tolls or parking fees.

How do I make a reimbursement form?

Information to include on an expense reimbursement form. Name of product or service. Individual item or line cost. Total cost. Payment method (i.e., cash, credit card, etc.) Date purchased. Explanation of purchase. Original or copy of the receipt.