HomeMy WebLinkAbout05-04-10 (3)AUTHORITY TO PAY COURT APPOINTED COUNSEL J~d • _ ,, nnan
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^ District Justice ^ Common Pleas O Appellate ^ Other N~ 13 6 0 2
3. FOR ( J., C.P., APPELLATE)
~ 4. AT (CITY/STATE) 5. BUDGET CODE
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6. tN THE CASE OI~~ C ~~,,, "[~ ~~ p~r/r
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~J ~ V ~ 7. CHARGE/OFFENSE (PU ON CITATION) 8. O PETTY OFFENSE
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9. PROCEEDINGS (D_es~c'ribe brielly)
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(~~CCL~ 1 t. PERSON REP ESENTED
1 O Defendant -Adult 12. CIVIL DOCKET NO.
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~i t 2 O Defendant -Juvenile f
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~ 3 O Appellant
a ^ Appellee
13. CRIMINAL DOCKET NO.
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~~~ 5 O Habeas Petitianar
.........JJJ 6 ^ Material Witness
10. PERSON REPRESENTED (Full Name) T ^ Parolee Charged With Violation
g ^ Probationer Charged With Violation
14.. APPEALS DOCKET NO.
use n 3 . (~ e ~ 9 Other.
/` ~,~-~ 16. NAME OF ATTORNEY/PAYEE AND ~ 9a Q
Appt Date Y ~ ~
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE
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17. TELEPHO E o. ` ~`~ 1 . scc~A~ sEC Y NO OR E W NO
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CLAIM FOR SERVICES OR EXPENSES ~°;"~..
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19. SERVICE HOURS DATES OUN LAII~~,~::~,
a. Arraignment and/or Plse to per dour tir'd,
b. Preliminary Hearing btain,~t Cour3"t~t~on>r
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Enter total b
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c Motions and Reduests ow;
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~ d Bail Hearings ~ ~ `K~_ -^""
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~ e. Sentence Hearings 1+.3
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Z f. Trial y") ~ `i,~
g. Revocation Hearings
h. Juvenile Hearings
i. Appeals Court 19A. TOTAL IN COURT COMP.
1. Other (Specify on additional sheets) ~ CCU Q~ ~~ ~ ~ /
TOTAL HOURS a X~PER'HOUR ~ $
20. a_ Interviews and conferences ~ Multiply rate per hour times total
LL' ~ b. Obtaining and reviewing records hours. Enter total "Out of Court"
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c. Legal research and brief writing
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on below.
~ OV d. Investigative and other work (Specify on additional sheets) 20A. TOTAL OUT OF COURT
COMP.
TOTAL HOURS = 1 ~ ~ ~ X $45 PER HOUR ~ $ ltJ ~~ ~~
2t• ITEMIZATION OF REIMBURSABLE EXP ENSES AMT. PER ITEM
Milage $.48 per mile X "" '~
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21 A. TOTAL ITEMIZED EXP.
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22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAIMED
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Has compensation and/or reimbursement for work in this case proviousy been applied fort ^ YES Gt NO = s
If yes, were you paid? ^ YES YVO If yes
by whom were you paid? How much?
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Has the person represented pa' any money to you, or to your knowledge anyone else, In connection with the matter for 24. DEDUCT. PRIOR PYMTS.
which you were appointed to provide represent 1 ^ YES NO 1 es. give details on a t nal s ets a S
1 swear or affirm the truth or correctness ~7~
of the above statements Signature of A /ayes Oata 25: NET A UNT CLAIMED
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Fc~u Signature of 27. AMT. APPROVED
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Co~ji 1 -Mail to hurt Administrator at completion of service