HomeMy WebLinkAbout07-06-12AUTHORITY TO PAY COURT APPOINTED COUNSEL
t. COURT
O District Justice Common Pleas ^ A 2. vOUC
ppellate ^ Other NO 1 ~ C ~ e
3. FOR (D.J., CnP, APPELLATE) 4. AT (CITY/$TgTjr) 1 tl y p p
(/ I~ ~ O/' ~,K, f `('w'~ / ~ ~O 5. BUDGET CODE
6. IN THE CASE OF f S / '~ ~~ 5 t~f'f~~~' ./
/^~ / T n ~ 7. CHARGEIOFFENSE (PUROON CITATION) 8. O PETTY OFFENSE
9. PROCEEDIN (Describe briefly)
~~~. iy. N ~S Q~ ~ Caper
~PiK0~1 +` dnzl j~~erc,~-
10. PERSON REPRESENTED (Full Name)
~~RDA G. 7J~~ws
Appt Date - •a ` ~%Z.
^ FELONY p MISDEMEANOR
11. PERSON REPRESENTED 12. CIVIL DOCKET NO.
t ^ Oefendent • Adult
2 ^ Defendant • Juvenile //.~ t~jy
~~ ~ Z, / c ~ 7
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3 O Aopeltant /
4 O Appellee 13. CRIMINAL DOCKET NO
5 O Mabess Petitioner .
6 ^ Material Witness
7 O Parolee Charged With Violation
e ^ Probations/r harped With Violation
g ~Oth~ ~l ~K~tP~~~t~r 14. APPEALS DOCKET NO.
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NAME OF COMMON PLEAS JUDGE SSIGNED TO CASE
9• SERVIC
a Arraignment and/or Plea
b. Preliminary Hearing
C Motions and Requests
d Bail Hearings
~
U e. Sentence Hearings
f. Trial
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g. Rsvocatbn Hearings
h. Juvenile Hearings
~ Appeals Court
4 Other (Specify on additional sheets)
20. a interviews and conferences
u, b. Obtaining and reviewing records
~ j t Legal research and brief writin
O U g
d. invesdgadvs and other work (Spec
1
m11ea8e i per mile x
TOTAL HOURS =
tt Please contact Court Administrator for current mllea
W
~ ~ ge ret@
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off- ~-
~7L 0
16. NAME OF ATTORNEY/PAYEE ANO
MA,IeLING AOORESS ~r,~,
4/ f ~ JK JP7G« "'~1 ~ ~e'S d.
~20l ~~ ~.
17. TELEPHONE No. it3. OREwrvo
-z ~-~y6 y ~s =~ ~y6 6
OR EXPENSES
RmuuN rs CLAIMED
Multiply rate per hour times total
hours to obtain "In Court" com-
pensation. Ep(Er total below.
Q
G..
rat-' t
~'' it
("t Z
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PER ROUR = $ ~ ~ ~-
6 ~ t: Multiply rate per hour times total
hours. Enter total "Out of Court"
compensation below.
20A. TOTAL OUT OF COURT
COMP.
X $45 PER HOUR = S / 3 ~ ~
22. CERTIFICATION OF ATTORNEY/PAYEE
Has compensation and/or reimbursement for titrork in this t:ase fxnsvkway been applied for? p YES ~NO
11 yes, were you paid? ^ YES ONO If yes, by whom were you psiti? Mow much?
Has the person represented paid any money to you, or to your knowledge artyone else, in connection with the matter for
which you ware appointed to provide represent n? YES ~ N If yes, give details on additio shes
I swear or affirm the truth or correctness 2
of the above statements d se
28.~4vwUVE u Date
F()N $igneture OI ~'~
ParraENr Judge ~
Date:
Copy t -Mail to Court Administrator at completion of service
CLAIM FOR
TOTAL HOURS =
on additional sheets)
21A. TOTAL ITEMIZED EXP.
s fY1
'23. tIRAND TOTS AL C{,AfMEO~
24. DEDUCT. P TOR PYMTS.
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25: NET AMOUNT' C IMED
27. AMT. AP OV_ED
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