PAYMENT SCHEDULE:

Pursuant to Indiana Code 4-7-1-2(10), and in order to ensure the security, management, and predictability of funds remitted to the State, the Auditor of State (AOS) will require any and all political subdivisions or officers charged with collecting and remitting or disbursing—to AOS— fines and forfeitures; fines and fees; and all Settlement related collections, to complete and comply with this electronic payment agreement (“AGREEMENT”) form to direct deposit by electronic funds transfer (EFT) all the aforesaid payments to the Auditor of State, in accordance with statutory due dates, into a financial institution and account designated by AOS.

SECTION 1: AUDITOR OF STATE FINANCIAL INSTITUTION INFORMATION

All payments listed in the Payment Schedule below shall be submitted via EFT, into the Auditor of State’s Financial Institution, on or by, the date listed in the Payment Schedule. Upon completion of this form, you will receive an email with the Auditor of State’s Financial Institution information which should be completed in conformance with this AGREEMENT.

SECTION 2: POINT OF CONTACT

Please provide the contact information of the person responsible for answering questions regarding payments received from the political subdivision or officer in accordance with this AGREEMENT.

Name: Enter Full Name

Title: Enter Title

Email:Enter email address

Phone: Enter Phone Number

SECTION 3: AGREEMENT

☐By checking this box, I, Enter Full Name, Enter Official Title of Enter Name of Political Subdivision or Office, am signing this AGREEMENT electronically in conformity with the Uniform Electronic Transactions Act. I agree my electronic signature is the legal equivalent of my manual signature on this AGREEMENT. By checking the box, I agree to comply with the Indiana Auditor of State’s Settlements Department E-Payment Policy. I understand that failure to submit payments to the Auditor of State via electronic funds transfer by the due date required by law (as outlined in the Payment Schedule below), or otherwise fail to secure a waiver, that my payment may be denied and may result in being charged interest and damages if a conforming payment is not received by the Auditor of State within the time prescribed by law.

***Please return completed AGREEMENT Forms to ***

Type of Payment: / Indiana Code Section: / Funds Due:
Fines and Forfeitures / IC 20-49-3-16 / On May 1 and November 1 each year.
Judges Supplemental / IC 33-38-5-6 / On Feb. 1, May 1, Aug. 1, Nov. 1 each year.
All Settlement Related monies reported on Certificate of Settlement / IC 6-1.1-27-3 / By June 30 and December 31 each year.
Fines and Fees:
INFRACTION JUDGEMENT / IC 34-28-5-5 / By June 30 and December 31 each year.
OVERWEIGHT VEHICLE FINE / IC 9-20-4 / By June 30 and December 31 each year.
SPECIAL DEATH BENEFIT / IC 35-33-8-3.2 / By June 30 and December 31 each year.
SALE DISCLOSURE FEE / IC 6-1.1-5.5 / By June 30 and December 31 each year.
CORONER’S CONTINUING EDUCATION FEE / IC 16-37-1-9 / By June 30 and December 31 each year.
ADULT & JUVENILE OFFENDER INTERSTATE COMPACT FEE / IC 11-13-4.5-4 / By June 30 and December 31 each year.
MORTGAGE RECORDING FEE / IC 24-9-9-1 / By June 30 and December 31 each year.
CHILD RESTRAINT FINE / IC 9-19-11 / By June 30 and December 31 each year.
CANINE RESEARCH AND EDUCATION FUND / IC 6-9-39 / By June 30 and December 31 each year.
SEX/VIOLENT OFFENDER REGISTRATION FEE / IC 36-2-13-5.6 / By June 30 and December 31 each year.
DLGF HOMESTEAD PROPERTY DATABASE FUND / IC 6-1.1-12-37(f) / By June 30 and December 31 each year.
VIOLENT CRIME VICTIMS COMPENSATION FUND / IC 11-10-8-6(a) / By June 30 and December 31 each year.

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