United States Court of Appeals for the Fourth Circuit
Voucher for Printing Services in Court-Assigned Cases
In Case/Matter Of (Case Name) Appeals Docket Number
Request and Authorization for Printing Services Attorney's Statement Full Name of Person Represented: Date of Assignment: As the attorney for the person represented who is named above, I hereby affirm that the services requested were necessary for adequate representation. I hereby request approval for services already obtained.
Signature of Court-Assigned Attorney Claimant's Certification Payee's Name, Mailing Address, and Telephone Number Amount Claimed: $ Date of Service: Description of Service:
I hereby certify that the attached invoice is correct and that I have NOT claimed or received payment from any other source for the services rendered and claimed on this voucher.
Signature of Claimant/Payee Approved for Payment - Court Use Only
Financial eligibility of the person represented having been established to the Court's satisfaction, the authorization requested is hereby granted.
$ Signature of Chief Judge, Court of Appeals (or delegate) Amount Approved Date