HomeMy WebLinkAbout06-20-12f 1
AUTHORITY TO PAY COURT APPOINTED COUNSEL ~ 1 0
t. COURT 2. VOUCHER
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^ District Justice Common Pleas ^ APPellate ^ Other
3. FOR (DJ., C.P., APPELLATEI 4. AT (CITY/STATE) GET CODE
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6. IN THE CASE OF 7. CNARGE/OFFENSE (PURDON CITATIONI 8. O PETTY OFFENSE
t?C.4V'Ser-, O FELONY O MISDEMEANOR
9. PROCEED~ING""S (Describe briefly) ~~p
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"_~ 11. PERSON REPRESENTED
1 ^ LMIenCSnl-Adult 12. CIVIL DOCKET NO.
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CRIMINAL DOCKET NO.
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5 ^ Habeas Petitioner
6 ^ Malarial Witnee!
10. PERSON REPRESENTED (Full Name) 7 ^ ParPlee Cnarped Wilh vioblion
e ^ Proeanoner Cnarped with Violation
14. APPEALS DOCKET NO.
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~'~ i 6. NAME OF ATTORNEY/PAYEE AND
MAILING ADDRESS
APPI Dale
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NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE U
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17. TELEPHONE No. te. socinLSECUNnrwo onew Ho
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CLAIM FOR SERVICES OR EXPENSES
7g, SERVICE HOURS DATES AMOUN LAIMED
a. Arreipnment and/or Plse y rate pe-Tibur ti 1
b. Prebminery Hearing t0 pbtai Cou
Ign. Entetal be -
c Motlana and Reouesta N ~.,~.~. ~~
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d Beil Hearings T.
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e. Sentence Hearings ~ '
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= 1. Trial ].~~~ ~ ,~,'
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g. Revocation Heennpa TTTt
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h. Juvenile Haerinpe .
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i. Appeals Court 19A TOTAL IN RT COMP.
j. Olher ($paGify on edtlitlpnel ehee[al •(, ~ a~-rlj.
TOTAL HOURS= %$55 PER HOUR - $ ~ ~~
20. a Inierviawa and cpnflrencea Mulbply rata per (lour times Total
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Out o
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hours.
LL b. Oblaininp and raviewinp records compensation below.
O S u Legal researcn antl brief writing
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O U d. Invesdgetlve and other work (Specify on adGdonal sheets) 20A TOTAL OUT OF COURT
COMP.
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TOTAL HOURS= ~ X$45 PER HOUR
2t. ITEMIZATION OF REIMBURSABLE EX PENSES AMT. PER ITEM
Miles e $ per mile x
w Please contact Court Administrator for current mileage rate
~ 22A TOTAL ITEMIZED FY^
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22. CERTIFICATION OF ATTORNEY/PAYEE 23. ORAND TOTA LAIMED
Has compensation andfw reimbursement for work In Ufa ws provlousy been apPllstl lo/! ^ YES ZXNO = S ~ ~ I
Il yes,were you paid? OYES ^ NO llye4 bywhom wero you pdC/ How much? PRIOR PYMTS.
24. DED CT
Has the person represented paid arty money to you, a to your knowledge anyone else, In connectlpn with the matter for .
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ee
which you were appointed to provide represent DYES NO 1 ye4 iv etaile on additional sh
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I swear or affirm the truth or cortectneaa r M a I I .f~12-,
25: NET AMOUNt CLAIMED
of Ina above statements $Ignatwa M AbomeylPayea ! ~ Date = S -
26 n,•wtom o ~
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1 2T. AMT. APPROVED
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Copy 1 -Maio Court Administrator at completion of service