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cja31 Death Penalty Proceedings Ex Parte Request for Authorization and Voucher for Expert and Other Services

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CJA 31 DEATH PENALTY PROCEEDINGS: EX PARTE REQUEST FOR AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES (Rev. 08/12)1.  CIR./DIST./ DIV. CODE2.  PERSON REPRESENTED VOUCHER NUMBER
 
3.  MAG. DKT./DEF. NUMBER 4.  DIST. DKT./DEF. NUMBER5.  APPEALS DKT./DEF. NUMBER6.  OTHER DKT. NUMBER
7.  IN CASE/MATTER OF (Case Name) 8.  TYPE  PERSON REPRESENTED 9.  REPRESENTATION TYPE	
’Adult Defendant	’Appellee	’D1 28 U.S.C. § 2254 Habeas (Capital)	’D4 Other (Specify)	’Habeas Petitioner	’Other (Specify)	’D2 Federal Capital Prosecution	’D7 State Clemency	’Appellant	’D3 28 U.S.C. § 2255 (Capital)	’D8 Federal Clemency
10.  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.	
REQUEST AND AUTHORIZATION FOR EXPERT SERVICES	11.  ATTORNEY’S STATEMENT As the attorney for the person represented, who is named above, I hereby affirm that the services requested are necessary for adequate representation.  I hereby request:	
’Authorization to obtain the service.  Estimated Compensation and Expenses: ZOR’Approval of services already obtained to be paid for by the United States pursuant to the Criminal Justice Act.   (See Instructions)
Signature of Attorney Date	
’	Panel Attorney	’Retained Attorney	’Pro-Se	’Legal Organization
ATTORNEY’S NAME (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS	
Telephone Number:	12.  DESCRIPTION OF AND JUSTIFICATION FOR SERVICES (See Instructions)	13.  TYPE OF SERVICE PROVIDER	 (See Instructions)
01	’Investigator 17	’Hair/Fiber Expert
02	’Interpreter/Translator 18	’Computer (Hardware/
03	’Psychologist    Software/Systems)
04’Psychiatrist 19	’Paralegal Services
05	’Polygraph 20	’Legal Analyst/Consultant
14.  COURT ORDER Financial eligibility of the person represented having been established to the Court’s 06	’Documents Examiner 21	’Jury Consultant
satisfaction, the authorization requested in Item 11 is hereby granted. 07	’Fingerprint Analyst22	’Mitigation Specialist
08	’Accountant 23	’Duplication Services
Signature of Presiding Judge or By Order of the Court 09	’CALR (Westlaw/Lexis, etc.)24	’Other (Specify)
10	’Chemist/Toxicologist
11’Ballistics 25	’Litigation Support
Date of Order Nunc Pro Tunc Date
13	’Weapons/Firearms/Explosive ExpertServices
14’Pathologist/Medical Examiner 26	’Computer Forensics
Repayment or partial repayment ordered from the person represented for this service at time of authorization. 15	’Other Medical Expert	’	YES	’NO 16	’Voice/Audio Analyst	15.  STAGE OF PROCEEDING	Check the box which corresponds to the stage of the proceeding during which the work claimed at Item 16 was performed even if the work is intended to be used in
connection with a later stage of the proceeding.  CHECK NO MORE THAN ONE BOX.  Submit a separate voucher for each stage of the  proceeding.
CAPITAL PROSECUTION	
HABEAS CORPUS	OTHER PROCEEDING	a.	’Pre-Trial e.	’	Appeal g.	’Habeas Petition k.	’Petition for the   l.	’Stay of Execution o.	’	Other (Specify)
b.	’Trial f.	’	Petition for the gg.	’State Court Appearance U.S. Supreme Court  m.	’Appeal of Denial of Stay
c.	’Sentencing U.S. Supreme Court h.	’Evidentiary Hearing Writ of Certiorari   n.	’Petition for Writ ofp.	’	Clemency
d.	’Other Post Trial Writ of Certiorari i.	’Dispositive Motions Certiorari to the U.S.
j.’Appeal Supreme Court Regarding
Denial of Stay
    CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY
16.      SERVICES AND EXPENSES
             (Attach itemization of services with dates) AMOUNT CLAIMEDMATH/TECHNICAL
ADJUSTED AMOUNT ADDITIONAL
REVIEW
a.  Compensation	
b.  Travel Expenses  (lodging, parking, meals, mileage, etc.)
c.  Other Expenses
GRAND TOTALS (CLAIMED AND ADJUSTED):	17.  PAYEE’S NAME  (First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS
TIN:
Telephone Number:
CLAIMANT’S CERTIFICATION FOR PERIOD OF SERVICE FROM TO
CLAIM STATUS	
’	Final Payment	’	Interim Payment Number	’Supplemental Payment
I hereby certify that the above claim is for services rendered and is correct, and that I have not sought or received payment  (compensation or anything of value) from any other source for these services.
Signature of Claimant/Payee Date	
18.  CERTIFICATION OF ATTORNEY   I hereby certify that the services were rendered for this case.	
Signature of Attorney Date	
APPROVED FOR PAYMENT — COURT USE ONLY
19.  TOTAL COMPENSATION 20.  TRAVEL EXPENSES 21.  OTHER EXPENSES22.  TOTAL AMOUNT APPROVED/CERTIFIED
23.	
’	Either the total cost  (excluding expenses)  of all services combined does not exceed $800, or prior authorization was obtained; OR	’	In the interest of justice the Court finds that timely procurement of these necessary services could not await prior authorization, even though the cost  (excluding expenses) exceeds $800.
Signature of Presiding Judge DateJudge Code
24.  TOTAL COMPENSATION 25.  TRAVEL EXPENSES26.  OTHER EXPENSES27.  TOTAL AMOUNT APPROVED	
28.  FOR REPRESENTATIONS COMMENCED AND A PPELLATE PROCEEDINGS IN WHICH AN APPEAL IS PERFECTED ON OR AFTER APRIL 24, 1996, 	A. Total compensation and expense payments approved to date (include amounts withheld for interim payments) for investigative, expert and other services for this
representation is $
B. Payment approved (compensation and expenses) in excess of the statutory threshold for investigative, expert and other service s under 18 U.S.C. § 3599(g)(2).
Signature of Chief Judge, Court of Appeals (or Delegate) DateJudge Code
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