Free PDF - Massachusetts

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS PURCHASE ORDER/REQUEST FOR PAYMENT FOR INTERPRETING SERVICES PLEASE PRINT OR TYPE

V.

CASE NUMBER:

FROM: Name

Street

City

Zip

Social Security Number

Telephone Number

I hereby certify that I am Certified to interpret in the following Language TYPE OF PROCEEDINGS: Description: Location:

Prof. Qualified

Non-Certified and executed a contract with the Court on ________________

DATE:

Begin Time:

am/ pm

End Time:

am/pm

HALF DAY

FULL DAY

AMOUNT

Distance from residence to location must be more than 30 miles one way in order to claim any travel expenses. TRAVEL EXPENSES: # OF MILES TOLLS @ $ PER MILE AMOUNT AMOUNT

$0.00
$0.00

PARKING

OTHER EXPENSES: (Itemize and attach receipts)

AMOUNT

Courtroom Deputy/Pretrial/Probation verification that Information is correct and accurate:__________(initials)

DOCUMENT TRANSLATION: DATE: TOTAL # OF WORDS/PAGES RATE PER WORD AMOUNT OTHER EXPENSES: AMOUNT

$0.00

TOTAL AMOUNT OF INVOICE:

$0.00

Date:

Submitted by: (Interpreter's Signature)

Date approved __________________

Certifying Officer _____________________________ Title _______________________

________092000-DXXBBCX-D01MAXJ/M-2523 INTERPRETER RATES: Effective April 1, 2009 Certified and Professionally Skilled - Full Day $384 / Half Day - $208 Overtime $54 per hour of part thereof Language Skilled (Non-Certified) - Full Day - $185 / Half Day - $102 Overtime $32 per hour or part thereof ** Mileage - 55 cents as of 2/1/09

(InterpreterInvoice.wpd - 4/1/09 - previous editions obsolete)