Free CJA 20 - Appointment of and Authority to Pay Court Appointed Cousel - Missouri

OCJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT APPOINTED COUNSEL (Rev. 5/99)
1. CIR./DIST./ DIV. CODE 3. MAG. DKT./DEF. NUMBER 7. IN CASE/MATTER OF (Case Name) 2. PERSON REPRESENTED 4. DIST. DKT./DEF. NUMBER 8. PAYMENT CATEGORY VOUCHER NUMBER 5. APPEALS DKT./DEF. NUMBER 9. TYPE PERSON REPRESENTED 6. OTHER DKT. NUMBER 10. REPRESENTATION TYPE (See Instructions)

G Felony G Misdemeanor G Appeal

G Petty Offense G Other

G Adult Defendant G Juvenile Defendant G Other

G Appellant G Appellee

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

G O Appointing Counsel G F Subs For Federal Defender G P Subs For Panel Attorney

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

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

Prior Attorney's Appointment G Because the above-named person represented has testified under oath or has 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 represent this person in this case, OR G 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 appointment. G YES G NO

CLAIM FOR SERVICES AND EXPENSES
CATEGORIES (Attach itemization of services with dates) 15. 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: a. Interviews and Conferences b. Obtaining and reviewing records c. Legal research and brief writing d. Travel time 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.) HOURS CLAIMED TOTAL AMOUNT CLAIMED

FOR COURT USE ONLY
MATH/TECH. ADJUSTED HOURS MATH/TECH. ADJUSTED AMOUNT ADDITIONAL REVIEW

16.

17. 18.

GRAND TOTALS (CLAIMED AND ADJUSTED):
19. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE 20. APPOINTMENT TERMINATION DATE IF OTHER THAN CASE COMPLETION 21. CASE DISPOSITION

Out

of

Court

In

TO: 22. CLAIM STATUS

G Final Payment

G Interim Payment Number

G Supplemental Payment

Have you previously applied to the court for compensation and/or reimbursement for G YES G NO If yes, were you paid? G YES G NO 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 representation? G YES G NO If yes, give details on additional sheets. I swear or affirm the truth or correctness of the above statements. Signature of Attorney Date

APPROVED FOR PAYMENT -- COURT USE ONLY
23. IN COURT COMP. 24. OUT OF COURT 25. TRAVEL EXPENSES 26. OTHER EXPENSES DATE 31. TRAVEL EXPENSES 32. OTHER EXPENSES DATE 27. TOTAL AMT. APPR./CERT. 28a. JUDGE/MAG. JUDGE CODE 33. TOTAL AMT. APPROVED 34a. JUDGE CODE

28. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER 29. IN COURT COMP. 30. OUT OF COURT

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