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CJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT APPOINTED COUNSEL (Rev. 5/99) 1. .CIR./DIST./DIV. CODE

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2. PERSON REPRESENTED 4. DIST. DKT./DEF. NUMBER

VOUCHER NUMBER

3. MAG. DKT./DEF. NUMBER 7. IN CASE/MATTER OF (Case Name)

5. APPEALS DKT./DEF . NUMBER

6. OTHER DKT. NUMBER

8. PAYMENT CATEGORY 9. TYPE PERSON REPRESENTED 10. REPRESENTATION TYPE Petty Offense Felony (See Instructions) Adult Defendant Appellant Misdemeanor Juvenile Defendant Other Appellee Appeal Other 11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense.

12. ATTORNEY'S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS

13. COURT ORDER O Appointing Counsel F Subs For Federal Defender P Subs For Panel Attorney
Prior Attorney's Appointment

C Co-Counsel R Subs For Retained Attorney Y Standby Counsel

Telephone Number: 14. NAME AND MAILING ADDRESS OF LAW FIRM (Only provide per instructions)

Because the above-named person represented has testified under oath or has otherwise satisfied this Court that he or she (1) is financially unable to employ counsel and (2) does not wish to waive counsel, and because the interests of justice so require, the attorney whose name appears in Item 12 is appointed to represented this person in this case, OR Other (See Instructions)

Signature of Presiding Judicial Officer or By Order of the Court

Date of Order Nunc Pro Tunc Date Repayment or partial repayment ordered from the person represented for this service at time appointment. YES NO

CLAIM FOR SERVICES AND EXPENSES
CATEGORIES (Attach itemization of services with dates.) 15 . HOURS CLAIMED TOTAL AMOUNT CLAIMED

FOR COURT USE ONLY
MATH/TECH. ADJUSTED HOURS MATH/TECH ADJUSTED

AMOUNT

ADDITIONAL REVIEW

In

a. Arraignment and/or Plea b. Bail and Detention Hearings c Motion Hearings d. Trial e. Sentencing Hearings f. Revocation Hearings g. Appeals Court h. Other (Specify on additional sheets) (RATE PER HOUR = $

) TOTALS:

16 .

Out of 17. 18.

a. Interviews and Conferences b. Obtaining and reviewing records c. Legal research and brief writing d. Travel lime e. Investigative and other work (Specify on additional sheets) (RATE PER HOUR = $ ) TOTALS: Travel Expenses (lodging. parking, meals. mileage, etc.) Other Expenses (other than expert, transcripts, etc) 20. APPOINTMENT TERMINATION DATE IF OTHER THAN CASE COMPLETION
Supplemental Payment NO 21. CASE DISPOSITION

GRAND TOTALS (CLAIMED AND ADJUSTED):
19. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE TO: 22. CLAIM STATUS
Final Payment Interim Payment Number

If yes, were you paid? Have you previously applied to the court for compensation and/or reimbursement for this YES NO YES Other than from the Court, have you, or to your knowledge has anyone else, received payment (compensation or anything of value) from any other source in connection with this
If yes, give details on additional sheets. representation? YES NO I swear or affirm the truth or correctness of the above statements. Signature of Attorney Date

APPROVED FOR PAYMENT
23. IN COURT COMP. 24. OUT OF COURT COMP. 25. TRAVEL EXPENSES

COURT USE ONLY
26. OTHER EXPENSES 27. TOTAL AMT. APPR./ CERT.

28. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER

DATE

28a. JUDGE/MAG. JUDGE CODE

29. IN COURT COMP.

30. OUT OF COURT COMP.

31. TRAVEL EXPENSES

32. OTHER EXPENSES DATE

33. TOTAL AMT. APPROVED 34a. JUDGE CODE

34. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE) Payment approved in excess of the statutory threshold amount.