cja20_5 Appointment of and Authority to Pay Court-Appointed Counsel

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OCJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COUR	T-APPOINTED COUNSEL (Rev. 12/03)	
1.  CIR./DIST./ DIV. CODE 2.  PERSON REPRESENTED VOUCHER NUMBER	
 	3.  MAG. DKT./DEF. NUMBER 4.  DIST. DKT./DEF. NUMBE R 5.  APPEALS DKT./DEF. NUMBER 6.  OTHER DKT. NUMBER
7.  IN CASE/MATTER OF  (Case Name)8.  PAYMENT CATEGORY 9.  TYPE PERS ON REPRESENTED 10.  REPRESENTATION TYPE	
GFelony	GPetty Offense	G	Adult Defendant	G	Appellant	(See Instructions)	GMisdemeanor	GOther	G	Juvenile Defendant	G	Appellee	GAppeal	G	Other	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),    13.  COURT ORDER
AND MAILING ADDRESS	
G	O  Appointing Counsel	G	C   Co-Counsel	G	F   Subs For Federal Defender	G	R   Subs For Retained Attorney	G	P   Subs For Panel Attorney	G	Y   Standby Counsel	
Prior  Attorney’s Name:
     Appointment Dates:
G	Because the above-named person represented  has testified under oath or has otherwise 
Telephone Number : 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 intere sts of justice so require, the attorney whose
name appears in Item 12 is appointed to  represent this person in this case, OR
14. NAME AND MAILING ADDRESS OF LAW FIRM  (Only provide per instructions)	
G	Other (See Instructions)
Signature of Presiding  Judge  or By Order of the Court
Date of Order Nunc  Pro Tunc Date
Repayment or partial repayment  ordered from the person represen ted for this service at time
appointment.	
G	YES	G	NO	
                            CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY	
CATEGORIES  (Attach itemization of services with dates) HOURS
CLAIMED TOTAL
AMOUNT
CLAIMED MATH/TECH.
ADJUSTED HOURS MATH/TECH.
ADJUSTEDAMOUNT ADDITIONAL
REVIEW
15. a.  Arraignment and/or Plea
 In Court
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:
16. a.  Interviews and Conferences
  Out of Court
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:
17. Travel Expenses  (lodging, parking, meals, mileage, etc.)
18. Other Expenses  (other than expert, transcripts, etc.)	
GRAND TOTALS (CLAIMED AND ADJUSTED):19.  CERTIFICATION OF ATTORNEY/PAYEE FOR THE PE RIOD OF SERVICE 20.  APPOINTMENT TERMINATION DATE 
       IF OTHER THAN CASE COMPLETION 21.  CASE DISPOSITION
        FROM:
TO:
22.  CLAIM STATUS	
GFinal Payment	GInterim Payment Number	GSupplemental Payment
Have you previously applied to the court fo r compensation and/or reimbursement for this	
GYES	GNO If yes, were you paid?	GYES	G	NO
Other than from the Court, have you, or to y our knowledge has anyone else, received payment  (compensation or anything of value) from any other source in connection with this 
representation?	
GYES	GNO              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 COMP. 25.  TRAVEL EXPENSES 26.  OTHER EXPENSES 27.  TOTAL AMT. APPR./CERT.
28.  SIGNATURE OF THE PRESIDING  JUDGE DATE 28a.  JUDGE CODE
29.  IN COURT COMP. 30.  OUT OF COURT COMP. 31.  TRAV EL EXPENSES 32.  OTHER EXPENSES 33.  TOTAL AMT. APPROVED
34.  SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE)  Payment approvedDATE 34a.  JUDGE CODE
        in excess of the statutory threshold amount.