HomeMy WebLinkAbout10-05-09AUTHORITY TO PAY COURT APPOINTED COUNSEL
1. COURT
^ District Justice ^ Common Pleas ^ Appellate lYOther ~~Dh qn t / od/T-
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE)
6. IN THE CASE OF 7. CHARGE/OFFENSE (PURDON CITATION)
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9. PROCEEDINGS (Describe briefly)
10. PERSON REPRESENTED (Full Name)
Appt Date
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QIN S~(~ ~~ X009
2. VOUCHER
N~ 13531
.BUDGET CODE
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8. OPETTY OFFENSE
O FELONY O MISDEMEANOR
11. PERSON REPRESENTED 12. CIVIL DOCKET NO.
1
2 O
O Defendent -Adult
Defendant • Juvenile
~ / ~ ~ ~ ,~. D 7d
3
O
Appel-ant ,
4 O Appellee 13. CRIMINAL DOCKET NO.
5 O Habeas Petitioner
ti ^ Material Witness
7 O Parolee Charged With Violation
8 O Probationer Charged With Violation 14. APPEALS DOCKET NO.
9 (YOther. ~//r~ ,,vim ~^ Gd~~
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16. NAME OF ATTORNEY/PAYEE AND ~33~g
MAIL
ING ADDRESS
D o ~ .'of
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}~~- ~/ I'h : /l ~~ it /q..!/e,- L 4s~ F /~ ..+ Lt ~
NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE ~r° f"' ~ ~ v D,n eaa~
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19.
CE
a. Arraignment and/or Plee
b. Preliminary Hearing
c Motions and Requests
~ d Bail Hearings
~ e. Sentence Hearings
O
U t. Trial
2
g. Revocation Hearings
h. Juvenile Hearings
i. Appeals Court
I. Other (Specify on additional aheets-~Sr-< v ~ry~~~d,
TOTAL HOURS
20. a. Interviews and conferences
~ b. Obtaining and reviewing records
t`
O ¢ c. Legal research and brief writing
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Q ~ d. Investigative and other work (Specify on additional sheets)
21.
Q
W
H
O
mile x
TOTAL HOURS =
OF REIMBURSABLE EX
~ v `~'/ / 7 /0 4
I • d X PER HOUR
f • 3 ~'iy o • S> /iy o
~~ I /
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D.o
S ' ~ X $45 PER HOUR
DES AMT. PER I
'~~ 22. CERTIFICATION OF ATTORNEY/PAYEE ~
Has compensation and/or reimbursement for work in thla case proviousy been applied for? p YES f.3 NO
II yes, were you paid? ~ YES ONO If yes. by whom were you paid? How much?
Has the person represented paid any money to you, or to your knowle~ anyone else, in connection with the matter for
which you were appointed to provide represent on?^ p YES iYNO If yes dive details on additional sheets
I swear or affirm the truth or correctness ~~. _~/ a~~0 q
of the above statements Signature of tt may/P e
26.A+'P+~uvt c, Date
Fua Signature of / /''`
nAVMENt Judge , ~ ~ / j „
(/ l/ ~ - Date: ~ ~ ..~~ -~~
' 17. TELEPHONE No.
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CLAIM FOR SERVICES OR EXPENSES
HOURS _ DATES
18. SOCIAL SECURITY NO OR EIN NO
AMOUNTS CLAIMED
Multiply rat `" p r hour times total
hours to ot~1~ In Cou~'om-
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9A. TOTAL ~N.000AT'G(3l~AP.
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Multiply rate per hour times total
hours. Enter total "Out of Court"
compensation below.
20A. TOTAL OUT OF COURT
COMP.
=s ~y 7,s~
21A. TOTAL ITEMIZED EXP.
=s C'. 00
23. GRAND TOTAL CLAIMED
=s ~4~. s~
24. DEDUCT. PRIOR PYMTS.
= S O . DO
25: NET AMOUNT CLAIMED
ss~4a.s0 ,/
27. AMT. APPROVED
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`J~ C~pY 1 -Mail to~ourt Administrator at completion of service