"Master Invoice Tally" - Ohio

Master Invoice Tally is a legal document that was released by the Ohio Department of Mental Health and Addiction Services - a government authority operating within Ohio.

Form Details:

  • Released on February 18, 2021;
  • The latest edition currently provided by the Ohio Department of Mental Health and Addiction Services;
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OHIO DEPARTMENT OF MENTAL HEALTH & ADDICTION SERVICES
(OhioMHAS)
PROBATE COURT SUBSIDY REIMBURSEMENT INVOICE
(Section 5122.43 Ohio Revised Code)
MASTER INVOICE TALLY
COUNTY OF:
CASES HEARD IN THE MONTH OF:
FISCAL YEAR:
TOTAL NUMBER OF CASES FOR THIS MONTH:
(To be completed by OhioMHAS)
TYPE OF COST
# OF INCIDENTS
COURT COST
OhioMHAS
ALLOWABLE
BASE RATE
COST
$
54.00
POLICE
$
$
$
27.00
SHERIFF
$
$
$
153.00
PHYSICIAN
$
$
$
100.00
WITNESSES
$
$
$
51.00
TRANSPORTATION
$
$
CONVEYANCE
$
6.00
ASSISTANTS
$
$
$
119.00
ATTORNEYS
$
$
REFEREES/
$
116.00
MAGISTRATES
$
$
$
33.00
REPORTERS
$
$
$
19.00
OTHER COURT COSTS
$
$
TOTAL COSTS FOR THE MONTH
$
REIMBURSE
$
PREPARED BY:
CONTACT PHONE NO.
DATE OF PREPARATION:
Revised 2/18/2021
OHIO DEPARTMENT OF MENTAL HEALTH & ADDICTION SERVICES
(OhioMHAS)
PROBATE COURT SUBSIDY REIMBURSEMENT INVOICE
(Section 5122.43 Ohio Revised Code)
MASTER INVOICE TALLY
COUNTY OF:
CASES HEARD IN THE MONTH OF:
FISCAL YEAR:
TOTAL NUMBER OF CASES FOR THIS MONTH:
(To be completed by OhioMHAS)
TYPE OF COST
# OF INCIDENTS
COURT COST
OhioMHAS
ALLOWABLE
BASE RATE
COST
$
54.00
POLICE
$
$
$
27.00
SHERIFF
$
$
$
153.00
PHYSICIAN
$
$
$
100.00
WITNESSES
$
$
$
51.00
TRANSPORTATION
$
$
CONVEYANCE
$
6.00
ASSISTANTS
$
$
$
119.00
ATTORNEYS
$
$
REFEREES/
$
116.00
MAGISTRATES
$
$
$
33.00
REPORTERS
$
$
$
19.00
OTHER COURT COSTS
$
$
TOTAL COSTS FOR THE MONTH
$
REIMBURSE
$
PREPARED BY:
CONTACT PHONE NO.
DATE OF PREPARATION:
Revised 2/18/2021