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Get MO Form A 15-1 2017

Email completed addendum to PolysubFS auditor. mo. gov or mail to Missouri State Auditor s Office P. OFFICE OF THE STATE AUDITOR ADDENDUM Form A 15-1 Rev 6-2017 INSTRUCTIONS Fill out via computer print to apply signature. No Total Annual Revenue Annual General Operating Revenue Total revenue from fines bond forfeitures and court costs for municipal ordinance violations and B minor traffic violations including amended charges for minor traffic violations Percentage of annual general operating revenue from fines bond forfeitures and court costs for C municipal ordinance violations and minor traffic violations REPRESENTATIVE S CERTIFICATION The undersigned representative of the county city town or village hereby certifies under penalties of perjury that all of the information submitted in this addendum is true and complete. Signature Typed or Printed Name Title NOTARY Subscribed and Sworn Before Me This Day of Year Notary Public Signature My Commission Expires Notary Public Name Typed or Printed County or City of St. Louis NOTICE Only a county city town or village that has chosen to have a municipal court divisions is required to submit an addendum to the State Auditor s Office under sections 479. If a county city town or village s total gross revenue from the operation of its municipal court including all fees fines bond forfeitures and court costs retained by the county city town or village from any case heard in its municipal court is less than the statutory percentage of annual general operating revenue over which the proceeds must be distributed to the schools annually as provided by Section 479. 359 the county city town or village may report its total gross revenue from the operation of its municipal court in lieu of reporting its total revenue from fines bond forfeitures and court costs for municipal ordinance violations and minor traffic violations occurring within the county city town or village. Political Subdivision Number Name of County City Town or Village Mailing Address Phone City Fiscal Year End MM/DD/Year State Zip Email Address Does your county city town or village have its own municipal court Yes A fines bond forfeitures and court costs for municipal ordinance violations and minor traffic violations List any courts that hear municipal violations for your county city town or village. 359 and 479. 362 and 15 CSR 40-3. 170. Please use this space to provide additional explanations if the space provided for any item was not sufficient. .

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