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Home My WebLink About09-22-06 .)~ AUTHORITY TO PAY COURT APPOINTED COUNSEL 1. COURT o District Justice 0 Common Pleas 3. FOR (D.J., C.P., APPELLATE) o Appellate 0 Other 4. AT (CITY/STATE) Carlisle PA 7. CHARGE/OFFENSE (PURDON CITATION) 6. IN THE CASE OF Estate of Glenwoed Brown, Sr 9. PROCEEDINGS (Describe brielly) Appointed to represent minor in an hearing awarding property with no appointed trustee. 11. PERSON REPRESENTED estatE 1 0 Delend.nt-Adult 2 0 Defendant. Juvenile 3 0 Appellant 4 0 Appellee 5 0 Habeas Pelitioner 6 0 Material WItness T 0 Parolee Cllarged Witll Violation 8 0 Probationer Cllarged Witll Violation 9 :m Otller: minor 10. PERSON REPRESENTED (Full Name) Christopher Junior Brown, minor RECF:l\TET) a~ '- - '.... .. .... 'lnnr:' ~J ~. VN~' ,~vl1 ~ ~ 0 6 ~ 71J7J-)O~~-I,bdV4t 8. 0 PETTY OFFENSE o FELONY 0 MISDEMEANOR 12. CIVIL DOCKET NO. 21-05-0468 13. CRIMINAL DOCKET NO. 14. APPEALS DOCKET NO. 16. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS Stephen J. Hogg, Esquire 19 S. Hanover St., Ste. 101 Carlisle, PA 17013 Appl Date 08/06 J. Wesley Oler, Jr. NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE 19. SERVICE 17. TELEPHONE No. (717)245-2698 CLAIM FOR SERVICES OR EXPENSES HOURS DATES ~ a: ::) a o ~ a. Arraignment aneUor Plea b. Preliminary Hearlno c. Motions and ReQue.ts c1 Bail Haarings It. Sentence Hearings I. Trial g. Revocation Hearings h. Juvenile Hearings i. Appeals Court ~ Other (Specify on additional sheetslhearing-estate mat:t:er TOTAL HOURS ,. 1 . 5X $55 PER HOUR ..1J1 J.J_~1 jiy." ~ (~'" PPui- A.. ) !!n~^~ I ' (J 1.50 08/28/06 20. a Interviews and conferences u.. ~ b. Obtaining and reviewing records a a: c. Legal research and brief writing 1-::) 5 8 d. Investigaliw and olher work (Specify on additional sheets) 1.00 1.00 TOTAL HOURS.. 2.00 X $45 PER HOUR AMT. PER ITEM 21. ITEMIZATION OF REIMBURSABLE EXPENSES Milage $.345 per mile x a: w X I- a \F 22. CERTIFICATION OF ATTORNEY/PAYEE Has compensation and/or reimbu,.ement for work In thla cue prevloualy been applied for? 0 YES Xl NO If yes. were you paid? 0 YES 0 NO Ify... by whom were YO~d? How much? Has the person represented paid any money to you. or to your '':; - nyone elae,ln connection with Ule f9atter for -' L..t.' "7L7~ T,j, _.... -"""tiL. .....t which you were appointed to provide representation? . ' -7/..P' r ryo f ._, ~- detaila on llWUt ts I swear or affirm the truth or corr.ectness / // P / /7 ""7 ~ ~ .....7'/< ~/ // ~ of the above statements ./ Signature of ~~~? {(...... Date ~. J /;//<-477 /5fe~ . .Oate: ~,J IS: 2'cb Cojy'1 - Mail to ~rt Administrator at completion of service 26 A"P'lCNl (II . . FOil Sognature of PAVMENI Judge ~ 1/ ~"J.J 18. SOCIAL SECURITY NO OREIN NO 23-252-9152 AMOUNTS CLAIMED Multiply rate per hour times total hours to obtain "In Court- com. pensatlon. EnhtDtotal below. :2 g:C:J =="" 0 c:I" .~, 1:T' ~~ ~ ~~ - ,) (.~C) ': ,>', .;;:::, -0 , 1 ::::n 19~OTAL "~OURf~. . ~ .. r""' r 1"1 .D . ,-, (:-3 -> 0 '-' -'7, -$ ~ l1.5b Multiply rate per hour times total hours. Enter total "Out of Court" compensation below. 20A. TOTAL OUT OF COURT COMPo .. $ 90.00 21A. TOTAL ITEMIZED EXP. -s I~ 23. GRAND TOTAL CLAIMED - $ 172A'O /5'1. )b 24. DEDUcT PRIOR PVMTS. -$ 25:NET A~OUNf CLAIMED -$ /S7__J;() 27. AMT. APPROVED -$ I <1:] ~O .,)". ' ... Form W-9 Request for Taxpayer Identification Number and Certification Give form to the requester. Do not send to the IRS. (Rev. November 2005) Department of the Treasury Internal Revenue Service N Q) Ol m Co <:: o all! ~~ ...(,) 02 1:'lii 'C .5 Q.(,) 1;: 'u al Co (J) Q) Q) en Name (as shown on your income tax retum) Stephen J. Hogg, Esquire Business name, if different from above D Partnership D Other ~ ___ _ _ ___ __ _ ___ _ _ _ D Exempt from backup withholding ~ IndividuaV Check appropriate box: Sole proprietor Address (number, street, and apt. or suite no.) 19 S. Hanover St. Ste. 101 City, state, and ZIP code Carlisle, PA ]7013 Ust account number(s) here (optiona~ D Corporation Taxpayer Identification Number (TIN) Requester's name and address (optionaQ Enter your TIN in the appropriate box. The TIN provided must match the name given on .Une 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. ~ or Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup Withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person ~ncluding a U.S. resident alien). Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payment ther than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the inst on page 4.) Sign Here Signature of U.S. person ~ Purpose of Form A person who is required to file an informatio IRS, must obtain your correct taxpayer ident' Ion number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. In 3 above, if applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.s. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. For federal tax purposes, you are considered a person if you are: Date ~ . An individual who is a citizen or resident of the United States, . A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or . Any estate (other than a foreign estate) or trust. See Regulations sections 301.7701-6(a) and 7(a) for additional information. Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: . The U.S. owner of a disregarded entity and not the entity, Cat. No. 1 0231 X Form W-9 (Rev. 11-2005)