Juror Donation Form
Dear Juror: Thank you for your jury service in ____________________________ County, Texas. You will receive $_________ for every full or partial day you serve. You are entitled to keep the pay you will receive for your service. You do have the option of donating your pay to certain programs specified below. If you wish to retain your pay for jury service, you do not need to complete this form. If you wish to donate your pay, please complete the lower portion of this form. Thank you.
County Clerk
I wish to donate my pay for jury service to: _____ the compensation to victims of crime fund under Subchapter B, Chapter 56, Code of Criminal Procedure. _____ the child welfare service fund under Chapter 264, Family Code. _____ ___________________________________________________________________. _____ __________________________________________________________________.
Juror Name: ___________________________ Date: _____________________
Juror Signature: _________________________
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