REPARATIONS ROTARY REPORTING FOR COURTS

TOS ACCOUNT NUMBER (Required):

COURT NAME:

COURT ADDRESS:

NAME AND TITLE PHONE NUMBER

EMAIL ADDRESS  Please check if there has been a change to the contact information

REPORTING MONTH & YEAR:

1)Victims of Crime(ORC 2743.70) $

2)Address Confidentiality Program (ORC 2929.18, 2929.28)$______

3)Additional Costs/Fines (ORC 2949.091,4511.19,120.08, 2949.094) (A),4503.235 (B),5502.67, 5502.68 (C)

  1. IndigentDefense Support Fund (GRF) $
  2. Drug Law Enforcement/Justice Program Services$

4)State Highway Patrol (ORC 5503.04) $

5)Liquor Control Fines (ORC 4301.57) $

6)Expungements (ORC 2953.1 – 2953.36)$

7)Child Safety Restraint (ORC 4511.81)$

8)Public Safety Highway Purposes Fund (ORC 4510.13) (A)(10) $

9)Legal Aid Society Fund – (ORC 1901.26, 1907.24, 2303.201less 1% administrative costs)

  1. Number of Small Claims Cases @ $11 each: # ______
  2. Number of Civil Cases @ $26 each: # ______
  3. Number of Domestic Relation Cases @26 each (except domestic violence): # ______
  4. Number Juvenile Cases @ $15 each (custody, visitation and parentage) # ______
  5. Number of cases moving from Small Claims to Civil @ $15 each: # ______
  6. Number of no fee cases: # ______
LEGAL AID SOCIETY FUND TOTAL: $ ______

9a) Child Abuse Prevention Fees (ORC 3109.13-3109.18 less 3% admin costs) $

9b) Family Violence Prevention Fees (ORC 3705.242 less 3% admin costs) $

Penalty (if applicable) $

Number of Dissolutions # Number of Divorces #

Number of Birth Certificates # Number of Death Certificates #

10) Seat Belt Fines (ORC 4513.263) $

Number of Driver Tickets # Number of Passenger Tickets #

11) Ohio Putative Fathers Registry (OPFR) (ORC 3107.062) $

TOTAL AMOUNT REMITTED $

Note: Per OAC 113-1-06, all payments of $100.00 or more must be made by electronic funds transfer through the Treasurer of State's online payment processing system at tos.ohio.gov/reparationsrotary.

State Treasurer of Ohio

P.O. Box 665  Columbus, Ohio 43216-0665

Revised 6/2017