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I{) PAID TO STATE TREASURY I GENERAL FUND / HEALTH & HUMAN <br />SERVICES COMMISSION: <br />1. <br />Total paid to State Treasury due to laek ofloeal agreement pursuant to 59.06 (c): <br />$ 0 <br />2. Total paid to State Treasury due to participating in task force not established in <br />accordance with 59.06 (q)(1): <br />$ <br />3. <br />Total paid to General Fund pursuant to 59.06 (C-3) ( c) (Texas Depatsnent of 1 <br />0 <br />Public Safety only): <br />$ <br />0 <br />4.) Total forfeiture funds transferred to the Health and Human Services Commission <br />pursuant to 59.06 (p): <br />$ <br />0 <br />5) TOTAL PAID TO STATE TREASURY I GENERAL FUND I HEALTH & <br />HUMAN SERVICES COMMISSION OUT OF CHAPTER 59 FUNDS: <br />$ <br />L) <br />TOTAL PAID TO COOPERATING AGENCY(IES) PURSUANT TO <br />$ 0 <br />LOCAL AGREEMENT: <br />M) <br />TOTAL OTHER EXPENSES PAID OUT OF CHAPTER 59 FUNDS <br />WHICH ARE NOT ACCOUNTED FOR IN PREVIOUS CATEGORIES <br />S 0 <br />(provide detailed descriptions on additional sheet(s) and attaeb to this <br />report): <br />N) <br />TOTAL EXPENDITURES: <br />$ 31 ,055.9 <br />NOTE: BOTH CERTIFICATIONS MUST BE COMPLETED <br />AUDITOR I TREASURER I ACCOUNTING PROFESSIONAL CERTIFICATION <br />I swear or affirm that the Commissioners Court, City Council or Agency Head (if no governing body) has requested that <br />I conduct the audit required by Article 59.06 of the Code of Criminal Procedure and that upon diligent inspection of all <br />relevant documents and supporting materials, I believe that the information eonlained in this report is true and correct. <br />AUDITOR, TREASURER or <br />ACCOUNTING PROFESSIONAL <br />(Printed Name): <br />TITLE: I-1 in e{ v, e4e— bi ✓ eic— <br />SIGNATURE: <br />DATE: to I � 3't (4 <br />1 '� <br />AGENCY HEAD CERTIFICATION <br />I swear or affirm, under penalty of perjury, that I have accounted for the seizure, forfeiture, receipt, and specific <br />expenditure of all proceeds and property subject to Chapter 59 of the Code of CriminalProcednre, and that upon diligent <br />inspection of all relevant documents and supporting materials, this asset forfeiture report is true and correct and contains <br />all information required by Article 59.06 of the Code of Criminal Procedure. I further swear or affirm that all <br />expenditures reported herein were lawful and proper, and made in accordance with Texas law. <br />AGENCY HEAD (Printed Namc): \iQ ^ 5 l-`` 'R - �\a Coy <br />Form Dale UM 13 Page 5 <br />