Free CJA 20 - Appointment - District Court of Arizona - Arizona

- CJA 20 APPOINTMENT OF AND AUTHORITY T0 PAY COURT APPOINTED COUNSEL _________ F 1 LED • DGE
1. cIR.rDIsT.rDIv. CODE ·_ 2. PERSON REPRESENTED -‘ I _ VOUCHER NUM = EPe.._ IIUEICEIVED. _- 0 py I _
AZX _ - Graham, Wayne - _ S . . . , S ‘·p ‘ _ . .
3. MAG. DK]"..·'DEF. NUMBER . 4. DIST. DKTJDEF. NUMBER S. APPEALS DI . . -2:00.0009%-002 : - _ . A UUE _ j
1. IN CASEIMATTER OF (cm Narne) ‘ 8. PAYMENT CATEGORY 9. TYPE PERSON REPRESENTED 1 UH ’
I I · . i I ·
Graham v. Sclmro _ - _ Other _ Other: 1 . abeaa §T|qIIpg$ Op : = _ - T .
-;1_ QFE`EN§’E[S) CI-_);ARQEI) (Cite U.S. Code, Title gn Section) Itrmore than one offe · se, list (up I¤.,i'i·ve) major offenses ¤im‘s¤¤» !¢¤¤1‘d*¤E l° I
_ 12. ATTORNEYS NAME éFlrst_Name, MJ., Last Name, lttcludlng-any sutlk) 13. COURTIORDER ‘ _ . _ _ I II
AND MAILING ADDR SS . I I FF 0 Appointing Cutmsel [1 C CD-Counsel _ _ I I'· _
_ I V g 1; Subs For Fedeialbefender _ Q $ guI1sdFor Retained Attorney ` . _ _ -_
U _ l Subs For Pane Attorney tan by (Tnunse l I l . l
_` _ AZ . ‘ ‘ _ Pnor Attontey s Name: · _ - A _- _· . __ -
. _ _ _ V _ · - Appointment Date: _,_____ ._ I · I _ _
I _. ` II ‘ I' I · Z1 B th sho e-named personrepresented has testiti d oder oath or has II ’ _I I _
V - . II Dtlter•:l;:I;I:iaHIIed thIs court that he or she · '· . ally IInnIItle to employ eounsel and ‘_
-1-Ekphtmg Number, 866 (2) does not wish to waive counsel, an ·. - V use the Inte - ofjusttee so require, the
, attorney me appears In It 1 is appointed tu represent this p in this case,
14. NAME AND MAILING ADDRESS OF LAW FIRM(only provide per instructions) or W I 4/ I
THOMAS E. HANEY, P.C. D °"‘ “' ;" ( ` ’ I
Signa re of I Ilieer ur By Order o¤tl1e Court ·
I S I I __________________
AZ Date nfDr e . Nune Pro Tune Date `
- Repayment or partial repayntent ordered front the person represented for this service at
time of appointment. [1 YES [I NO -

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19. CERTIFICATION OF ATTORNEYIPAYEE FOR THE PERIOD OF SERVICE 20. APPOINTMENT TERMTNAITIDN DATE 11. CASE DISPOSITION
. tr OTHER THAN CASE COMPLETION
FROM ______________ T0 ____________,__,_
2.2. CLAIM STATUS I] FI 1 al Payment j Interim Payment Number ___,___,,_,,.,.,_ [Q Supplemental Payment I
Have you previously applied In the court for eornpuustlun nndlor rentlntbursement for this cue? I:] YES EI NO [t' yes, were you paid? EI YES CI NO
Other than from the court, have you, or to your knowledge has anyone else, received payment (compensation or anything or value) from any other source tn connection with this
representation? 1] YES [1 NO Ifyes, give details on additional sheets.
I swear or affirm the truth or correctness of the above statements. .
Slgznature ofAtt.orney: Date:
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23. IN COURT COMP. 14. OUT OF COURT COMP. 25. TRAVEL EXPENSES 26. OTHER EXPENSES 21. TOTAL AMT. APPRJCERT
28. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER DATE zsn. .1`UDGE.'MAG. moot; conn
19. IN COURT COMP. sn. OUT OF COURT COMP. 31. TRAVEL EXPENSES sz. OTHER EXPENSES aa. ·ro·rAL AMT. APPROVED
S4. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE)P¤;,1¤e111 DATE 34a. JUDGE CODE »
approved in excess ot' the statutory threshold amount.
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Case 2:00-cv-00936-SMM

Document 188

Filed 09/07/2005

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