Free INVOICE FOR INTERPRETER SERVICE (SCA-M-1036) - West Virginia

MAGISTRATE COURT OF
Plaintiff

COUNTY, WEST VIRGINIA

v.
Defendant

Case No.

INVOICE FOR INTERPRETER SERVICE
Interpreter Name: Social Security / F.E. I. N. #

ONLY SIGN LANGUAGE INTERPRETERS MUST INDICATE
(Name of business or individual requesting payment)
(address)

THEIR LEVEL OF CERTIFICATION.

Certification Level of Sign Language Interpreter:

NOTICE: The Administrative Office policy is that the fees for interpreters for a person who is hearing-impaired may not exceed the minimum fee chart set forth in the Commission for the Deaf and Hard of Hearing Rules without prior approval from the Administrative Office. The hourly fee for a foreign language interpreter is fixed by order of the appointing court. Reimbursement for reasonable and necessary expenses may not exceed the rates allowed in Section 10 of the Supreme Court personnel manual. Check appropriate box: foreign language. interpreter for person who is deaf or hard-of hearing, AND/OR interpreter for person who speaks a

HOURS: Dates:

Rate Set Forth in Order of Appointment is $ Hours @ Rate 1*
hrs x $ hrs x $ hrs x $ hrs x $

Hours @ Rate 2*
hrs x $ hrs x $ hrs x $ hrs x $

Hours @ Rate 3*
hrs x $ hrs x $ hrs x $ hrs x $

Total

Subtotal $ Total

EXPENSES: Dates:

Mileage
miles @ $ miles @ $ miles @ $ miles @ $

Meals

Lodging

Subtotal $ GRAND TOTAL $

*Rates
1 ­ Hourly rate set forth in Order of Appointment. 2 ­ Hourly rate set forth in Order of Appointment plus additional $5 per hour for interpreting in excess of 1 hour without a team interpreter. 3 ­ Hourly rate set forth in Order of Appointment plus additional $3 per hour for weekend hours.

I hereby certify all the above information to be true and that I have not previously billed another source nor received payment for the charges set out above.

Date

Signature of Interpreter

I hereby certify that the above is a true and accurate statement of service performed and of reasonable and necessary expenses actually incurred.

Date
SCA-M1036NP / 7-99

Signature of Magistrate