HomeMy WebLinkAbout05-04-10AUTHORITY TO PAY COURT APPOINTED COUNSEL ~~
1. COURT
^ District Justice ~ommon Pleas O Appellate ^ Other
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE)
6. IN THE CASE OF j~ C~ r , ~ ~ ~ ~-e ~~ 7. CHARGE/OFFENSE (PUROON CITATION)
9. PROCEEDINGS (Des n~be briell~
-.~i~-~~~ ~~ 11. PERSON REPR SENTED
~Ll-~ ~~~ {- 1 O Defendant -Adult
`~`~-~~ ~ ~lf~.~.C~l~ll~ 2 ^ Defendant • Juvenile
3 ^ Appellant
4 p Appellee
5 ^ Habeas PetitiOnar
6 ^ Material Witness
APR ~ 9110
2. VOUCHER
_ N° 13601
5. BUDGET CODE
/~ -~s~~'~o-Gaa~u~
8. O PETTY OFFENSE
O FELONY ^ MISDEMEANOR
12. CIVIL DOCKET NO.
~~~r1o _c~l~C~
13. CRIMINAL DOCKET NO
10. PERSON REPRESENTED (Full Name) 7 O Parolee Charged With Violation
8 O Probationer Charged With Violation 14. APPEALS DOCKET NO.
~ ` L {~ 9 ~Otner.
C`T'S 1~/1V1 ,`V1')
~~~ ~ Z , ~ /-~ t 6. NAME OF ATTORNEY/PAYEE AND .~f 3 (]~
Appt Date ~- l./ MAILING ADDRESS
~~. : ~- , 53c.~ GYec~on ~2c~
NAME OF COMMON PLE S JUDGE ASSIGNED TO CASE ~~Y,~S\~ J ~~ ~`7~15~
17. TELEPHONE No.
19. SERVIC
a. Arraignment and/or Plea
b. Preliminary Hearing
o Motions and Requests
d Bail Hearings
~ e. Sentence Hearings
U f. Trial
z
g. Revocation Hearings
h. Juvenile Hearings
i. Appeals Court
j. Other (Specify on additional sheets)
CLAIM FOR SERVICES OR EXPENSES
HOURS n
. .~
J "7.
'-~ l ~~
18GSOCIALf S`ECURITY,N+O/OF EiN N
t ~~ ~-F ~'" AFC ~~
TOTAL HOURS = ~~'~
X $~5 PER HOUR
20. a. Interviews and conferences /
~ b. Obtaining and reviewing records
O ~ c. Legal research and brief writing
t- ~
~ ~ d. Investigative and other work (Specify on additional sheets)
TOTAL HOURS = ~ X $45 PER HOUR
2t. ITEMIZATION OF REIMBURSABLE EXPENSES
Milage $. per mile AMT. PER ITEM
W .~ x L
_ ~V
H
0
22. CERTIFICATION OF ATTORNEY/PAYEE
Has compensation and/or reimbursement for work in this case proviousy been applied fort ^ YES ~NO
If yes, were you paid? ^ YES ONO If yes, bywhom were you paid? How much?
Has the person represented paid any money to you. or to your knowledge anyone else, in connection with the matter for
which you were appointed to provide represent ? O Y O
I swear or affirm the truth or correctness ~ yes. give details on d i ' ~ ~h e~
of the above statements S nature of Atto ayee
Date
26,nc'PgUvE U
FU~i Signature of
~'AYMENf Judge - _^/~, Z ~ O
Q..~~ -Date: ~-r t
v~~ pY 1 -Mail to Court Administrator at completion of service
AMOUNTS CLAIMED _
Multiply rate p1'1Vour times total
urs to obtaiisn Court" cox~-
lion. Entett:':total be±wy.; ,
_ ~...,
~- may' ~x
'X7' ~ C
I t` t. ' }''1
~ ~
fi ~ ~'
1 ~ TA L I N G'DU RT CO~F,~
G 7.
_ $ ~~
Multiply rate per hour times total
hours. Enter total "Out of Court"
compensation below.
20A. TOTAL OUT OF COURT
COMP.
$ ~-7~ - a0
21A. TOTAL ITEMI//ZED EXP.
a~'..~~j. ZV
X23. GRAND TOTAL CLAIMED
= x c~36
24. DEDUCT. PRIOR PYMTS.
as
25: NET AMOUNT CLAIMED
_: Ga.7
27. AMT. APPROVED
= S "~ ~ ~ ~ / .-.