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Reimbursement Form
Reimbursement may be obtained for certain reasonable expenses incurred by a party of a youth being served by the Dallas County Child Protection and Permanency Court.
Please complete the form below and click Submit when finished.
This is a privilege offered for youth being served by the Court and must be approved by Judge Gonzales prior to completion.
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* Indicates required question
Email
*
Your email
Re-enter e-mail address
*
Your answer
Original Cause Number of the case (DF-xx-xxxxx format)
*
Your answer
Name of Person Requesting Reimbursement (first name and last name)
*
Your answer
Affiliation to the case
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Your answer
Address to mail reimbursement check (street, city, state, zip)
*
Your answer
Your phone number if there are any questions
*
Your answer
Amount paid ($xx.xx format)
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Your answer
Item purchased for reimbursement
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Birth Certificate
Other:
Required
State purpose of item purchased for reimbursement
*
Your answer
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