County Auditor’s Form 346
Harris County, TX (REV. 8/12/2015)
JUROR’S DONATION AUTHORIZATION FORM
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NOTE:
INSTRUCTIONS
Complete this form ONLY if you wish to donate all or a portion of your reimbursement money.
Please print or verify your name, the beginning date of service, and your juror number.
Designate the amount you wish to donate - all or a specified dollar amount.
Designate the program to which you wish to donate. (Select only one applicable for trial duration.)
Return the completed and signed form to the Court Clerk on the last date of your jury service.
Incomplete or unsigned forms will result in automatic payment to the juror.
Juror’s Reimbursement Available for Donation:
I,
for
day(s) served.
, authorize Harris County to donate
All
or
$
of my juror reimbursement for service beginning
, to the Program indicated below.
PROGRAM NAME AND BRIEF DESCRIPTION
Preferred
Program
Program Name
Program Description
Victims of Crime Fund
Assists innocent victims of crime who have resulting expenses that cannot be
reimbursed from insurance or other sources, such as reasonable medical, counseling,
prescription, and rehabilitation expenses; certain funeral expenses; partial loss of
earning and support; and child care. The Office of the Attorney General administers the
fund under the statutory guidelines of the Texas Victims’ Compensation Act (Chapter
56 - Subchapter B, Texas Code of Criminal Procedure).
Children’s Protective
Services Child Welfare
Service Fund
Works with families toward resolving family problems and preventing the removal of
children from the home, placing a child in appropriate substitute care or adoption when
necessary, providing casework services to status offenders and children in need of
supervision, and providing children in agency custody with adequate medical care. The
executive director is responsible to the Children’s Protective Services Board, which is
appointed by Commissioners Court in accordance with Texas Family Code §264.005.
Harris County Veterans’
Treatment Court
Provides access to mental health and addiction treatment for veterans with felony and
misdemeanor offenses.
Child Advocates, Inc.
Mobilizes court appointed volunteers to break the cycle of child abuse and speak up for
and guide abused children into safe environments where they can thrive.
Crime Stoppers of
Houston, Inc.
Mission is to solve and prevent crime in the Greater Houston area in partnership with
citizens, media, and the criminal justice system.
Casa De Esperanza De Los
Niños, Inc.
Provides residential care for abused, abandoned, neglected, medically fragile, and HIV
affected infants and young children.
Tejano Center for
Community Concerns, Inc.
Provides support to improve life opportunities of low-income children and families
through education, social and health services, and community development initiatives.
The 100 Club, Inc.
Provides assistance to dependents of certified peace officers and firefighters who are
killed in the line of duty while protecting our lives and property.
ESCAPE Family Resource
Center
Supports prevention of child abuse and neglect before a child is hurt by providing
intervention, education, and support programs to families in crisis.
Houston Area Women’s
Center
Helps individuals affected by domestic and sexual violence in their efforts to move their
lives forward.
JUROR AUTHORIZATION
Signature of Juror
Juror Number
Date