HomeMy WebLinkAbout11-07-12oor 3 1 1~~2 ~"`
AUTHORITY TO PAY COURT APPOINTED COUNSEL
1. COURT 2. VOUCHER
^ District Justice Common Pleas ^ Appellate ^ Other N ~ ~. 4 6 6 0
3. FOR (D.J., C.P., APPELLATE 4. AT (CITY/STATE) 5. BUDGET CODE
6. IN THE CASE OF 7. CHARGEIOFFENSE (PURDON CITATION) 8. O PETTY OFFENSE
e~ O FELONY ^ MISDEMEANOR
9. PROCEEDINGS (Describe briefly) 1 1. PERSON REPRESENTED 12. CIVIL DO
CKET NO.
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•- endant • Juven
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3 O Appellant
13. CRIMINAL DOCKET NO.
4 ^ Appellee
5 ^ Habeas Petitioner
6 ^ Material Witness
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10. PERSON REPRESENTED (Full Name) olat
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7 ^ Parolee Charged With V
g ^ Probationer Charged With Violation
14. APPEALS DOCKET NO.
9 O Other.
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16. NAME OF ATTORNEY/PAYEE AND
Appt Date ~~-l;j°Z.. MAILING ADDRE¢~(JG ~
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE 1''~E'~'~' ~`t.)a-n~t~~f S~~~S -~~ ~ ~ ~ ~~
17. TELEPHONE No. 18. soc~At_sECURIrYrvo oREirvNo
CLAIM FOR SERVICES OR EXPENSES
19. SERVICE HOURS DATES AMOUNTS CLAIMED
a. Arraignment and/or Plea Multiply rate per hour times total
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b. Preliminary Hearing hours to obtain
In Court
com-
pensation. Enter total below.
c Motions and Requests ~w =~
t- d Bail Hearings ~"' °~~~ ~-} j ;~
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e. Sentence Hearings .' \~ /
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Z f. Trial ~ ~ ~;, .~ 2_0 ) ~ ~ I
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g. Revocation Hearings 'r~r ' --.1 ~
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h. Juvenile Hearings ~
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i. Appeals Court ~~ TOTAL IN'"~OURX~t~P.
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a
j. Other (Specify on additional sheets) .
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TOTAL HOURS = 1 .
~ X $~55 PER HOUR
20. a. Interviews and conferences ~ Multiply rate per hour times total
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b. Obtaining and reviewing records
?_, hours. Enter total
Out of Court
compensation below.
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~ c. legal research and brief writing ~ ; ~'
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Q O d. Investigative and other work (Specify on additional sheets) 20A. TOTAL OUT OF COURT
COMP.
TOTAL HOURS = ~ , (~ X $45 PER HOUR = $ Z~ Z ~ ~ ~ /
2t. ITEMIZATION OF REIMBURSABLE EX PENSES AMT. PER ITEM
Mileage $ •" ~ per mile x v
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w Please contact Court Administrator for current mileage rate
F. 21 A. TOTAL ITEMIZED EXP.
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22. CERTIFICATION OF ATTORNEY/PAYEE 23. GRAND TOTAL CLAIMED
Has compensation and/or reimbursement for work in thla case previously been applied fort OYES f~ t~0 = S ~~ ~ ~
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If yes, were you paid? OYES ONO Ityes, bywhom were you paid? How much?
24. DEDUCT. PRIOR PYMTS.
Has the person represented paid any money to you, or to your knowledge gone else, In connection with the matter for
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Tonal heats
E~ ENO If yes, give details on add
which you were appointed to provide repres ntati
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I swear or affirm the truth or correctness ~ ;T ~ ~1`-~ ~~ ~` ~ 25: NET AM UNT CLAIMED
of the above statements Signature of Attorney/Payee Date = S / ~~ 1,~
26.nr~anUVt t,
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Signature of ~~ ~ I ~Z~
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Jud 27. AMT. APPROVED
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Copy 1 -Mail to Court Administrator at completion of service