CIRCUIT COURT

DISTRICT COURT OF MARYLAND FOR
City/County

Located at

Case No.

SPECIAL OFFICER PETITION FOR LEGAL FEES For payment, a Special Officer Final Report must be submitted with this Petition.
Defendant Name of Panel Attorney (Type or Print) Firm of Panel Attorney

Street/Post Office Address

City, State and Zip Code Federal Identification/Social Security Number

Court:

Circuit Post-Conviction Other (Specify)

District

Juvenile Mental Health

Charge: I. OUT-OF-COURT PREPARATION: Interviews with Client Motions Filed Discovery Suppression Dismiss (Specify) Other (Specify) (hours) II. COURT APPEARANCES: Hearings on Motions Pre-Trial Conferences Other Pre-Trial Preliminary Hearing Arraignment Plea Trial Sentence Hearing Other (Specify) (hours)

TOTAL OUT-OF-COURT HRS.: I.

TOTAL IN-COURT HRS.:

II.

III. EXPENSES: Please submit a separate statement, on letterhead, of any expenses you have incurred, along with appropriate receipts, if available. TOTAL EXPENSES:

III.

CERTIFICATION: I hereby certify that the above hours and expenses are true and accurate and that compensation has not been received. I also certify that no payment or promise of payment has been requested or accepted for representing the above Defendant.
Signature of Attorney Date Telephone Number

CC-DC/JPR 7 (Rev. 10/2008)

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