HomeMy WebLinkAbout04-14-09AUTHORITY TO PAY COURT APPOINTED COUNSEL
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'APR 1 ~ 2049
2. VOU(:HER
1. COUAT
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^ District Justice Common Pleas ^ Appellate ^ Ot
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) 5. BUDGET CODE
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IN THE CASE OF
6 7. CHARGE/OFFENSE PURDON CITATION) 8. ^ PETTY OFFENSE
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f~ V7LC1 _i G'~' I ~„ / ~~ O FELONY ^ MISDEMEANOA
9. PROCEEDINGS (Describe briefly) 11. PERSON REPRESENTED 12. CIVIL DOCKET NO.
1 ^ Defendant • Adult ~' _ O Q - ~ ~ aQ
~ 2 O Defendant • Juvenile t 1
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V 3 ^ Appellant
13. CRIMINAL DOCKET NO.
4 ^ Appellee
5 ^ Habeas Pelitianer
6 ^ Material Witness
7 ^ Parolee Charged With Violation APPEALS DOCKET NO.
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10. PERSON REPRESENTED (Full Name) a O,, ~P obationer Charged with violation ,~,.J.
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Appt Date 16. NAME OF ATTORNEY/PAYEE AND
MAILING ADDRESS /~~0~
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NAME OF COMMON P AS JU GE ASSIGNED TO ASE /~~~~~ jCJ/~ I rIQ 13
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17. TELEPHONE No. 18. SOCIn~SEGURIir NO 0 EIN NO
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CLAIM FOR SERVICES OR EXPENSES
19 SERVICE HOURS DATES AMOUNTS CLAIMED
. a. Arraignment and/or Ples Multiply rate hour times total
hours to obt~"In Court" ~om•
b. Preliminary Hearing nsation. ErR~ total belo~e
c Motions and Requests
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~ Q. Bail Hearings ; 17 ~ .T7 c.."' - `
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~ e. Sentence kearings j`TJ ~
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U f. Trial ~
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? q, Revocation Hearings ~ n ~ .~~r ""~"~
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h. Juvenile Hearings -'
i. Appeals CouR f9 TAL IN URT`CQfy1Pt
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b Other (Specify on additional sheets) yy~r ~ ~J 1
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TOTAL HOURS = X PER HOUR
20. a. Interviews and conferences Multiply rate per hour times total
Enter total "Out of Court"
hours
LL b. Obtaining and reviewing records .
compensation below.
~ ¢ c. Legal research and brief writing
~ ~ d. Investigative and other work (Specify on additional sheets) 200. TOTAL OUT OF COURT
O U _ {, t r ~r r COMP
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TOTAL HC+UR3 = 3~ p2 X $45 PER HOUR (
$ / / / ,~O
2t. ITEMIZATION OF REIMBURSA6LE EX PENSES AMT. PER ITEM
Milage $. per mile x - 5 •l I eS ~'~~-f't~ S e
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~ EXP.
21 A. TOTAL ITEMIZED
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22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAtMEO
Has compensation and/or reimbursement for work in this case proviousy been applied for? ^ YES O Q
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Ifyes,wereyoupaid? ^ YES ^ NO Ifyes,bywhomwereyoupaitJ7 Howmuch7 24.OEDUCT. PRIOR PYMTS.
Has the person represented paid any money to you, or to your knowledge anyone else, In Connection with the matter for
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give details on additional sh ets
rovide representation? ^ YES ~/ If yes
ointed to
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you were app
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1 swear or affirm the truth or correctness ~ 25:NET AMOUNT CLAIMED
of the above statements 3 r Att /Payee Date s s .~ ~.
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Signature of
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Judge ~
Copy 1 -Mail to Court Administrator at completion of service
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