Free Pro Bono Fund Voucher and Request for Reimbursement - New York

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF NEW YORK PRO BONO FUND VOUCHER AND REQUEST FOR REIMBURSEMENT

I, represent v. Civil Action No. -CV-

, duly appointed as counsel pro bono to in the matter of

, hereby request reimbursement pursuant to Local Rule 83.3 .

for expenses incurred in the representation of my pro bono client in the amount of $ I certify that the expenses, a detailed copy of which are attached hereto, are reasonable and necessary. I further understand that absent prior approval of the court, cumulative expenses in this matter will not exceed $2,000.00. Dated: .

Counsel Pro Bono (Signature): The above application of counsel pro bono is fair and reasonable and payment is requested from the Northern District of New York's Pro Bono Fund. Dated: .

Presiding Judge (Signature): IT IS SO ORDERED. Dated: .

Chief U.S. District Judge