Complete the following form using the instructions provided below.

Department*

92nd District Court 93rd District Court 139th District Court 206th District Court 275th District Court 332nd District Court 370th District Court 389th District Court 398th District Court 430th District Court 449th District Court Adult Probation Auxiliary Court Budget & Management Buildings & Grounds Child Protective Court Child Welfare Commissioners' Court Executive Office Constable Precinct 1 Constable Precinct 2 Constable Precinct 3 Constable Precinct 4 Constable Precinct 5 County Auditor County Clerk County Court at Law #1 County Court at Law #2 County Court at Law #4 County Court at Law #5 County Court at Law #6 County Judge County Treasurer Court of Civil Appeals District Clerk District Attorney's Office Elections Department Emergency Services (Fire Marshal & Emergency Management) Health Department HIDTA Human Resources/Civil Service Human Services Indigent Defense Information Technology Justice of the Peace, Precinct 1, Place 1 Justice of the Peace, Precinct 1, Place 2 Justice of the Peace, Precinct 2, Place 1 Justice of the Peace, Precinct 2, Place 2 Justice of the Peace, Precinct 3, Place 1 Justice of the Peace, Precinct 3, Place 2 Justice of the Peace, Precinct 4, Place 1 Justice of the Peace, Precinct 4, Place 2 Justice of the Peace, Precinct 5, Place 1 Juvenile Justice Court Juvenile Probation Law Library Master Court I Master Court II Planning Department Precinct 1 Precinct 2 Precinct 3 Precinct 4 Probate Court Public Defender Right of Way Sheriff's Office Tax Office Texas Cooperative Extension Urban County Veteran's Services WIC Executive Office Other

Project Title*

Project Information

New or prior request?*

New Request

Prior Request

Identify the purpose of the expenditure from the options listed:*

Buildings and Improvements Infrastructure Land

Land Improvements Machinery and Equipment

Provide a clear and brief description of the scope and nature of your request.*

What needs will this project resolve?*

Estimated Cost Itemization

Indicate a (0) Zero for costs that are not applicable

Land Appraisals / Survey*

Land Acquisition / Row*

Architectural / Engineering*

Construction*

Inspections*

Field and Plant Equipment*

Vehicles*

Communications Equipment*

Computer / Software*

Office Equipment / Furniture*

Others (Please Describe)

Project estimated cost:*

Source of estimate:*

Construction Estimate Comparable Cost Estimate

Other Estimate

Project's anticipated useful life:*

1-5 Years 5-10 Years

10-15 Years Over 15 Years

Other comments regarding project costs:

By initialing here, I certify that I have the proper authority to complete and submit this form. *

Name*

Title*

If you have any questions regarding completion of this form, please contact Rey Salazar at X 5426.