Free Family Court invoice for Guardian Ad Litem (12-07) - West Virginia

Family Court Invoice for Guardian Ad Litem
Guardian Ad Litem Appointed on Behalf of:
child(ren) incarcerated adult adult committed to mental health facility

Name of Guardian Ad Litem _______________________________________________________ Name of Client: __________________________________ Name of Client: __________________________________ Name of Client: __________________________________ Client's Birth Date:___________________ Client's Birth Date:___________________ Client's Birth Date:___________________

Payment Information:
Name of Person or Firm Receiving Payment:_______________________________________________ Vendor's Social Security # or FEIN: Vendor's Address: ___________________________________________________ ___________________________________________________

City: ____________________________________________ State:________ Zip:____________ Phone: _______________ Fax: _______________ E-mail: _____________________________

Case Information
County: ______________________________________ Judge: _______________________________________ Petitioner______________________________________ Respondent___________________________ Civil Case No.:________________________

FEE TOTALS Fees Claimed:
GAL service of : Child (428)(429) Incarcerated adult (352)(353) Adult Committed to Mental Health Facility (354)(351) Incompetent Adult (350)(351)

$____________________

Mileage Claimed: $0.585 per mile (7-1-08) Total Claim for Proceeding (Fees + Mileage) Not to exceed $1,200.00(7-1-07)
*AFFIRMATION -

$____________________

$____________________

I hereby affirm that the above statements are true and correct and that during the time the charges occurred my appointment did not automatically end due to change in eligibility status of the client.

Attorney's Signature

Date

For office use only - Supreme Court Approval Signature:

Approved:

Date:

_____

SCA-F-405 (12/07)

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Attorney Name:___________________________ Case # _______________ County: _______________

THE FOLLOWING SERVICES WERE RENDERED IN THIS PROCEEDING:
TIME CODE CLASSIFICATIONS In Court- $65.00/hour
H = Hearings W = Waiting in Court O = Other (must specify)

Out-of-Court- $45.00/hour
D = Driving or Travel C = Conferences with client or witnesses R = Research, preparation of pleadings I = Investigation O = Other (must specify)

Itemized time must be in tenths of an hour.

Attach additional sheets if necessary.

# of Additional Time Sheets

DATE

TIME CODE

ATTORNEY TIME IN-COURT

ATTORNEY TIME OUT-COURT

LOCATION OF ACTIVITY; FURTHER EXPLANATIONS, NOTES OR COMMENTS

Total TOTAL FEES CLAIMED FOR THE ABOVE PROCEEDING Enter grand total from above chart and any attached charts

$

The Administrative office will return any Invoice with mathematical or other errors. If returned, you will need to obtain a corrected Order Approving Payment from the Judge.

SCA-F-405 (12/07)

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Attorney Name:___________________________ Case # _______________ County: _______________

II.

ALLOWABLE MILEAGE EXPENSES Mileage reimbursed at a rate of $0.585 per mile (7-1-08)
MILES TRAVELED MULTIPLY BY $.505 PURPOSE ORIGINATING CITY DESTINATION CITY

ONLY ONE ITEM PER LINE- Use only properly numbered additional sheets if necessary DATE

TOTAL

TOTAL MILEAGE EXPENSES CLAIMED FOR THE ABOVE PROCEEDING Enter total cost from above chart $__________________________

Please enter the following amounts below and also on page 1 of this voucher Total service fees claimed for this proceeding Total mileage claimed for proceeding INVOICE GRAND TOTAL $________________________ $ _______________________ $ _______________________

The Supreme Court will not reimburse guardians ad litem for office expenses including, but not limited to: long-distance telephone calls, postage, invoice preparation time, paralegal/secretarial services, copying expenses, and copying fees paid for medical records or court-related documents. Remittance Instructions: Attorneys: Please submit completed invoice to Family Court Judge's office. Family Case Coordinator or Secretary Clerk: Please submit original invoice and Order Approving Payment to the Clerk of the Circuit Court. Circuit Clerk: Please attach the original invoice to a certified "Order Approving Payment", including embossed seal, and submit both to: WV Supreme Court of Appeals Pepper Flenner 1900 Kanawha Blvd., E. Building 1, Room E-100 Charleston, WV 25305

SCA-F-405 (12/07)

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Attorney Name:___________________________ Case # _______________ County: _______________

ADDITIONAL ATTORNEY TIME SHEETS DATE TIME CODE ATTORNEY TIME IN-COURT ATTORNEY TIME OUT-COURT LOCATION OF ACTIVITY; FURTHER EXPLANATIONS, NOTES OR COMMENTS

Page Totals All itemized time must be in tenths of an hour.
SCA-F-405 (12/07)

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