HomeMy WebLinkAbout02-19-10AUTHORITY TO PAY COURT APPOINTED COUNSEL
1. COURT
^ District Justice 1~Common Pleas
3. FOR (D.J., ,APPELLATE)
^ Appellate ^ Other
4. AT (CITY/STATE)
e P P'
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 ~ ~ 0
11. PERSON REPRESENTED
t O Delsndsnt-Adult
2 O Defendant•Juvenile
3 ^ ADPellant
q ^ Appellee
5 ^ Habeas Petitioner
8 ^ Material Witness
7 O Parolee Charged With Violation
g O Probationer Charged With Violation
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE
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5. BUDGET CODE
Sao /sy~~o-Gaay~~
8. O PETTY OFFENSE
O FELONY O MISDEMEANOR
12. 6Nfi1. ppOC~KET NO.
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13. CRIMINAL DOCKET NO.
14. APPEALS DOCKET NO.
16. NAME OF ATTORNEY/PAYEE AND ~~ ~~~
MAILING ADDRESS
Mt~h~.~ ~: '~t/~nce
3~ €. Po~.~~.~ S~
C~ l,t, sta. Q A- 110 l3
17. TELEPHONE No.
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CLAIM FOR SERVICES OR EXPENSES
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a. Arraignment and/or Plea
b. '14aY~iaay Hearing
c Motions and Requests
r d. Bail Hearings
~ e. Sentence Hearings
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U 1. Trial
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g. Revocation Hearings
h. Juvenile Hearings
i. Appeals CouR
j. Other (SpeciN on additional sheets)
20. a. Interviews and conferences
b. Obtaining and reviewing records
v_
O ¢ G Legal research and brief writing
~ O d. Investigative and other work (Spec
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TOTAL HOURS'
on additional sheets)
TOTAL HOURS =
21
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0
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X PER HOUR
X $45 PER HOUR
22. CERTIFICATION OF ATTORNEY/PAYEE
Has compensation and/or reimbursement for work in this case previousy been apPlled for4 ^ YES ~! NO
II yes, were you paid? ^ YES ONO If yea, by whom were you pall? 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 representatjp~? QtY~ ~ f~ 'f yeA give details on a ditional sh ets
I swear or affirm the truth or correctness _-~ Slgnat a of Attomsy/Payee Date
of the above statements
28.^I'~cui, t u Signature of ~ Date: A ~ / ~ + /O
r'AYMENI I JUdQe 11 ~(, ~
r:nr,v Y Mall to t:~Urt Administrator at completion of service
/Qd' FEB 18 2010
18. SOCIAL SECURITY NO OREINNO
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AMOUNTS CLAIMED
Multiply rate per hour times total
hours to obtain "In Court" com-
pensation. Enter total below.
9A. TOTAL IN COURT COMP.
~~" 00
_ $
Multiply rate per hour times total
hours. Enter total "Out of Court"
compensation below.
20A. TOTAL OUT OF COURT
COMP.
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21A TOTAL ITEMIZED EXP.
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23. GRAND TOTAL CLAIMtED ,
24. DEDUCT. PRIOR PYMTS.
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25: NET AMOUNT CLAyI.M~E.D~
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27. AMT. APPROVED
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