Fillable County Clerk Remittance Form (PDF Fill-in Form) (Illinois State Treasurer's Office)

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County Clerk Remittance Form (PDF Fill-in Form) (Illinois State Treasurer's Office)

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BROWSE ILLINOIS STATE TREASURER'S OFFICE (IL) FORMS

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Mail Form and Check To: Office of the Illinois State Treasurer
Attn: Fiscal Operations
P.O. Box 10254
Springfield, IL 62791-0254
Make Checks Payable To: Treasurer of the State of Illinois
Name of Fund Check Number Check Amount
Domestic Violence Fund
COUNTY CLERK REMITTANCE FORM
OFFICE OF THE ILLINOIS STATE TREASURER
County Clerk Name
County Name
Contact Name
Contact Phone Number
Today's Date
Contact Jamie Usherwood at 217-558-2987 with any questions.
Form Revised 8/24/2018
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County Clerk Remittance Form (PDF Fill-in Form) (Illinois State Treasurer's Office)

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Completed 13 August 2020

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