Free 1-2-3 - Interpreter Attendance - Indiana

INTERPRETER
NAME: ADDRESS:

ATTENDANCE

RECORD

for DAILY USE ONLY
Presiding Official: THE HONORABLE ______________________________________________________ U. S. District Judge Magistrate Judge

LANGUAGE:

____________________________ CERTIFIED _____________ or NON-CERTIFIED _____________

(Spanish, Navajo, Haitian-Creole) :
SOC. SEC. NO.: TELEPHONE: DATE CASE NUMBER CASE NAME

All other languages: PROFESSIONALLY QUALIFIED ___________
TYPE OF HEARING START TIME COMPLETION TIME

or LANGUAGE SKILLED _______________
BILLABLE TIME AMOUNT OF SERVICES CLAIMED

TRAVEL TIME
RESIDENCE to COURTHOUSE COURTHOUSE to RESIDENCE

DEPARTED

ARRIVED

TOTAL SERVICES CLAIMED: TOTAL TRAVEL EXPENSES:

0 $0.00

TRAVEL EXPENSES

0.00 TOTAL NUMBER OF MILES: ____________ x
OTHER EXPENSES: Tolls Parking

cents =

$0.00

GRAND TOTAL:

$0.00

Total Other Expenses:

$0.00

Interpreter Signature

Date

Other

TOTAL TRAVEL EXPENSES:

$0.00

TO BE COMPLETED BY CASE MANAGEMENT DEPUTY:

This is to certify that _________________________________________________ did appear in court on ________________________________, as stated in the above attendance record and did perform the functions as set forth in the Order entered in this cause. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the seal of this court at _____________________________, Indiana, on ___________________.
Revised 2/08

STEPHEN R. LUDWIG, CLERK, by _________________________________________ , Deputy Clerk