HomeMy WebLinkAbout06-20-12AUTHORITY TO PAY COURT APPOINTED COUNSEL '~~~ JJI~ 1 1 2012
t. COURT 2.'/OUCHER
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^ District Justice ^ Common Pleas ^ Appellate ^ Other - ,
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) 5. BUDGET CODE
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6. IN THE CASE OF 7. CHARGE/OFFENSE (PURDON CITATION) 8. :7 PETTY OFFENSE
E ^ 'rELONY ^ MISDEMEANOR
9. PROCEEDINGS (Descri a briefly) 11. PERSON REPRESENTED 12. CIVIL DOCKET NO.
,1 `~~~n ~ ~~~P~.c~~ ~ 1 ^ Defendant-Adult
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2 O Defendant ~ Juvenile
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1-~~_~'V „~'~ ~~,Jl(,~' S ^ Habeas Petitioner
6 ^ Material Witness
7 ^ Parolee Charged With Violation 14 APPEALS DOCKET NO.
t0. PERSON REPRESENTED (Full Name) g ^ Probehoner Charged With Violation
g ^ Otner
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s,~ 16. NAME OF ATTORNEYIPAYEE AND
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE
EPfIONENO. 18. SOCiALSECUAiTVtvOOREiNNO
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CLAIM FOR S ERVICES OR EXPENSES
tg. SERVICE HOUP.S DATES AMOU CLAIMED
a. Arraignment end/or Pfes ply rate peUhour t ~al
to obta' In C
b. Preliminary Hearlnq at_ion. Enl~~total w
c Motions and Requests ~
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f- d. Bail Hearings ~? __ h) f ~ ' 4 T
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'O e. Sentence Hearinga ~ ~ G` ~'. "C1 ~'~
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g. Revocation Hearlnps .^ t"~
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h. Juvenile Hearings `-'O
i. Appeals Court 19A. TOTAL IPQOURT COM .
j. Other (Specify On additional sheets) t t'1t;.G'. ~ ~.. / 9 D
TOTAL HOURS = X $55 PER HOUR - $ ~' ~' ~O
20. a. Interviews and conferences Mutttply rate per hour times total
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u b. Obtaining and reviewing records (~ nter tOfe
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compensation below.
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c. Legal research and brief writing
~ d. Investigative and other work (Specify on additional sheets) 20A TOTAL OUT OF COURT
COMP.
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TOTAL HOURS = X $45 PER H
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2t. ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM
Mileage $ per mile x
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Please contact Court Administrator for current mileage rate
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22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL C tMED
Has compensation and/or reimbursement for work in this Case previously been applied for? OYES ~ NO = ; ~ ~ D
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Ifyes,wereyoupaid? ^ YES ^ NO If yes,bywhomwereyoupeid9 How much? PRIOR PYMTS.
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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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which you were appointed to provide represen n7 OYES ^ r~A If ye Hive details on additional sheets
1 swear or affirm the truth or conectness ~~~,(~ L S ( i v-P~ U 25: NET AMOUNT CLAIMED
Of the above statements Signature of Atto ~/Payee Date : _ ~ rl.
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~' 27. AMT. APPROVED
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Copy 1 -Mail •to Court Administrator at completion of service
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