Fill and Sign the A Ttachment a Form

Attachment A IN THE DISTRICT COURT OF ______________________ COUNTY STATE OF OKLAHOMA STATE OF OKLAHOMA) Plaintiff, )- vs -)CASE NUMBER)____________________________________________) Defendant, )(DOB: _______________________________________) A T T A C H M E N T A The Defendant, _____________________________________________, is ordered by the attached Judgment and Sentence to repay the Court Fund of ____________________________ County the following dollar amounts representing fines, costs and assessments resulting from his/her conviction. Monies collected shall be applied to the balance due in the order of priority listed on this Attachment. All fines, costs and assessments are due and owing from the date of Sentencing and must be paid in full by _______________________________ or the Defendant must reappear in this Court for further proceedings. Costs, such as appellate proceedings and transportation costs, may continue to accrue after judgment and sentence. Additional costs may be certified by the Court Clerk as they accrue. Schedule of Reimbursement 1. Court Costs$_______________________________2.Fines$_______________________________3.Attorney Fees$_______________________________4.CLEET$_______________________________5.OSBI Lab Fees$_______________________________6.County Sheriff$_______________________________7.Victim’s Compensation$_______________________________8. Restitution$_______________________________9.Drug Abuse Education and Treatment Fund$___________________________________________________________________________________________________________________________________ TOTAL $_______________________________============================= _____________________________________________ Judge of the District Court I certify that the foregoing figures are true and accurate to the best of my knowledge. _____________________________________________ Clerk/Deputy Date: ____________________________