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AUTHORITY TO PAY COURT APPOINTED COUNSEL l;~ JAN 082007 r
2,vN~HER 11619
5. BUDGET CODE J
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8. 0 PETTY OFFENSE
o FELONY 0 MISDEMEANOR
1. COURT
o Distnct Justice
'Common Pleas
o Appellate 0 Other
4. AT (CITY/STATE)
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3. ~f (OJ.. C.P.. APPELLATE)
6. IN THE CASE OF
\~ Re i~~,\'t,o (A.,,",11\I~-fS
9. PROCEEDINGS (Describe briefly)
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11. PERSON REPRESENTED
lODe/endS'll' Adull
2 0 Defendant. Juvenile
3 0 Appellant
4 0 Appellee
5 0 Habeas Pelltioner
6 0 Mate"al Witness
7 0 Parolee Charged With Violation
8 0 Probationer Charged With Violation
9~ Other I\LlCC,(i'J ItV{J:f't( j--o""VriJ
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10. PERSON REPRESENTED (Full Name)
KJ:J~ 'f\'\ ~H\) '0 C ~ti0Wf\ \ t ')"\ .s,
Apot Date I D F2-/lDJL?
I
EDV'II, PD
16. NAME OF ATTORNEY/PAYEE AND
MAILING ADDRESS
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE
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19.
SERVICE
17. TELEPHONE No.
7/7 z.. YI LIlt 3("
CLAIM FOR SERVICES OR EXPENSES
HOURS DATES
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a. Arraignment and/or Plea
b. Preliminary Hearing
c. Motions and ReQuests
d Ball Hearings
e. Senlence Hearings
t. Trial
g. Ravocation Hearings
h. Juvenile Hearings
i. Appeals Court
j. Other (Specify on additional sheets)
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5/5
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X 45 PER HOUR
'A/'. _ ,iAO/,,-'
IV/'i-tV TV
,
TOTAL HOURS ~
20.
a. Interviews and conferences
b. Obtaining and reviewing records
c. Legal research and briet writing
d. Investigative and other work (Specify on addilional sheets)
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TOTAL HOURS =
7.75
X $45 PER HOUR
21.
ITEMIZATION OF REIMBURSABLE EXPENSES
AMT. PER ITEM
Milage $.345 per mile x
PJ.;/nbr - ([71l!.1JiLJJt.. ~{)(UJs 70 JiU~t ) Lt. 'fl>
rot,! I/Vi.- eo,...,.."- fJ.1C(Ji~/L- R cwRX)(') -" 5, 7 Q
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22. CERTIFICATION OF ATTORNEY/PAYEE I
Has compensation and/or reimbursement for wort< In this cue previously been applied tor? 0 YES rrt NO
II yes. were you paId? 0 YES 0 NO If yes, by whom _re you paid? How much?
Has the person represented paid any money to you, or to your knowledjJ8'8nyone else, in connection with the matter for
whiCh you were appointed to provide repreS8ntatlo~ YEs..--,~IO II yes, give details on addit~e?~' sheets
I swear or a"lrm the truth or correctness ~ ~ /'k Z-Y /Y / / / 5r I 7{j.) I
ot the above stalements ..... /-Slgn.tta'.~Alt01l~/payee ( , Date
~ . Date: ,lq((J1
_ ~ ,::(, r
Copy 1 Mal' to Court AdminIstrator at completion of service
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26 APPHCJIJ([I\
. 'Oil Signature ot
PAYMENT Judge
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12. CIVIL DOCKET NO.
OC ~\-o~~ZiJ
13. CRIMINAL DOCKET NO.
14. APPEALS DOCKET NO.
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16; ~Al, sEcuiiii'S- NO OR EiNNiS;
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.. ,:,-'j d> ->
'-;~OUN~CLAIMED'-' ,
Mtl)t$ly r'ate per:hour limes lotaj
hoUr~ to obtairt..::ln Court" cp-mi
~neallion. Enlel'tolal below. .c.
. 0
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19A. TOTAL IN COURT COMPo
=$
Ill,SO
Multiply rale per hour limes tolal
hours. Enler lotal "Oul ot Court-
compensation below.
20A. TOTAL OUT OF COURT
COMPo
... $ J4 t .1~
Ii L)~1,25
21A. TOTAL ITEMIZED EXP.
.. $ ~ I. qo
23. GRAND TOTAL C~MED
... $ 52.2. ~~
24. DEDUCT._~RIOR PYMTS.
=$ \.0
25:NET A~OUNT CLAIMED
... $ SJ..:;)" (Q5
27. AMT. APPROVED r
=$ 5~'0.j
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