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CJA 21 AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES (Rev. 5/99) 1. CIR./DIST./DIV. CODE 2. PERSON REPRESENTED 3. MAG. DKT./DEF. NUMBER 7. IN CASE/MATTER OF (Case Name) 4. DIST. DKT./DEF. NUMBER 8. PAYMENT CATEGORY Felony Petty Offense Misdemeanor Appeal Other 5. APPEALS DKT./DEF. NUMBER 9. TYPE PERSON REPRESENTED Adult Defendant Appellant Juvenile Defendant Other: Appellee

VOUCHER NUMBER 6. OTHER DKT. NUMBER 10. REPRESENTATION TYPE (See Instructions)

11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense. REQUEST AND AUTHORIZATION FOR EXPERT SERVICES 12. ATTORNEY'S STATEMENT As the attorney for the person represented, who is named above, I hereby affirm that the services requested are necessary for adequate representation. I hereby request: OR Authorization to obtain service. Estimated compensation and $ Approval of services already obtained to be paid for by the United States pursuant to the Criminal Justice Act (Note: Prior authorization should be obtained for services in excess of $500.00, excluding expenses) Signature of Attorney Panel Attorney Retained Attorney Pro-Se Date Legal Organization

ATTORNEY'S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS Telephone: 13. DESCRIPTION OF AND JUSTIFICATION FOR SERVICES (See Instructions) 14. TYPE OF SERVICE PROVIDER 01 Investigator 02 15. COURT ORDER Financial eligibility of the person represented having been established to the Court's satisfaction, the authorization requested in Item 12 is hereby granted. Signature of Presiding Judicial Officer or By Order of the Court Date of Order for this service at time of YES 16. a. Compensation b. Travel Expenses (lodging, parking, meals, mileage, etc.) c. Other Expenses GRAND TOTAL (CLAIMED AND ADJUSTED): 17. PAYEE'S NAME (First Name, M.I., Last Name, including any suffix) AND MAILING ADDRESS TIN: Telephone: NO CLAIM FOR SERVICES AND EXPENSES SERVICES AND EXPENSES (Attach itemization of services with dates) Nunc Pro Tunc Date 03 04 05 06 07 08 09 10 11 13 14 Repayment or partial repayment ordered from the person represented Interpreter/Translator Psychologist Psychiatrist Polygraph Documents Examiner Fingerprint Analyst Accountant CALR (Westlaw/Lexis, etc.) Chemist/Toxicologist Ballistics Weapons/Firearms/Explosive Pathologist/Medical Examiner AMOUNT CLAIMED FOR COURT USE ONLY MATH/TECHNICAL ADJUSTED AMOUNT ADDITIONAL REVIEW 24 19 20 21 22 23

15 16 17 18

Other Medical Voice/Audio Analyst Hair/Fiber Expert Computer (Hardware/ Software/Systems) Paralegal Services Legal Jury Consultant Mitigation Specialist Duplication Services (See Instructions) Other (Specify)

CLAIMANT'S CERTIFICATION FOR PERIOD OF SERVICE FROM CLAIM STATUS Final Payment Interim Payment Number

TO Supplemental Payment

I hereby certify that the above claim is for services rendered and is correct, and that I have not sought or received payment (compensation or anything of value) from any other source for these services. Signature of Payee 18. CERTIFICATION OF ATTORNEY I hereby certify that the services were rendered for this case. Signature of Attorney Date

Date 22. TOTAL AMOUNT APPR./CERT.

19. TOTAL COMPENSATION 23.

APPROVED FOR PAYMENT - COURT USE ONLY 20. TRAVEL EXPENSES 21. OTHER EXPENSES

Either the cost (excluding expenses) of these services does not exceed $500.00, or prior authorization was obtained. Prior authorization was not obtained, but in the interest of justice the Court finds that timely procurement of these necessary services could not await prior authorization, even though the cost (excluding expenses) exceeds $500.00.

Signature of Presiding Judicial Officer

Date

Judge/Magistrate Judge Code

CJA 21 AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES (Rev. 5/99) 24. TOTAL COMPENSATION 25. TRAVEL EXPENSES 26. OTHER EXPENSES 28. PAYMENT APPROVED IN EXCESS OF THE STATUTORY THRESHOLD UNDER 18 U.S.C. § 3006A(e)(3)

27. TOTAL AMOUNT APPROVED

Signature of Chief Judge, Court of Appeals (or Delegate)

Date

Judge Code