Free CJA Payee Registration Form - New Hampshire


File Size: 39.5 kB
Pages: 1
Date: February 10, 2006
File Format: PDF
State: New Hampshire
Category: Court Forms - Federal
Author: danl
Word Count: 72 Words, 686 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.nhd.uscourts.gov/pdf/CJAPayeeRegistration.pdf

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United States District Court District of New Hampshire

CJA ATTORNEY PAYEE REGISTRATION

Name: Social Security #: Telephone: ______________________

INDICATE BELOW HOW PAYMENTS SHOULD BE REPORTED TO THE IRS

G

Under my social security number and name, as indicated above OR

G

To the law firm with which I am affiliated. The law firm's taxpayer identification number, name, and address are: Taxpayer ID #: Law Firm Name: Address: _________________________________________ _________________________________________ _________________________________________

Attorney Signature: _______________________________

Date: __________________

USCDNH-23A (11/00)(Previous Editions Obsolete)