Amador — Attorney Claim Form

Source: https://amador.courts.ca.gov/system/files/forms-and-filings/attorney-claimform.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF AMADOR

500 ARGONAUT LANE, JACKSON, CA 95642
Name, Address and Telephone No. of Attorney CLERK’S USE ONLY

Case No.

Case Title: Invoice Date:

COURT APPOINTED ATTORNEY CLAIM FORM AND ORDER/REIMBURSEMENT ORDER

CLAIM AND REQUEST FOR APPROVAL OF: ATTORNEY FEES INTERIM FINAL ATTORNEY’S EXTRAORDINARY FEES REIMBURSEMENT TO AMADOR COUNTY

To the Judge of the Superior Court:

On I was appointed to represent: pursuant to the provisions of:

Civil Contempt Probate Code Other:

Family Code 3150 W&I Code 317 (Juvenile Dependency)

Penal Code W&I Code 634 (Juvenile Wardship)

Billing Period: through TOTAL CLAIM $

Attorney billing shall be submitted monthly. Upon completion of the case, final billing shall be submitted within thirty (30) days. (See Local Rule of Court 6.20.2 and Appointed Services Fee & Expense Schedule).

I declare under penalty of perjury that the itemized statement and claim for services attached hereto are

correct and accurately reflects the time spend by me in this action.SIGN Date: Signature:

ORDER

This claim for approval of attorney fees may be used by the Court to make a determination of the amount for which a Defendant is responsible for reimbursing the County for provision of legal services pursuant to Court appointed counsel.

The Court having read and reviewed the claim submitted herein orders the following: Amount Approved $ Partial Amount Granted $ SIGN Date: Judge of the Superior Court

The Order Sealing the Request for Approval of Fees was made by the Court on: . As part of that Order, the invoice and the associated itemized billing are sealed. In order for the invoices to be paid, they must be sent to County officials. The court is hereby authorized to submit approved claim forms, without any itemized statements attached, to the County for payment. The Court sends the claim forms to GSA who in turn sends the forms to the auditor for payment. These County entities are hereby ordered to shred or maintain the claim forms confidentially and not release said claim forms to any other entity, unless authorized to do so by further order of this Court. The itemized statements are to be retained by the Court under seal. The Court’s fiscal department may maintain the documents in a locked file cabinet, in a separate file folder indicating they are “sealed.” The fiscal department shall not release the records or provide access to anyone, other than as provided by in this order, unless otherwise authorized by further Court Order.

COURT APPOINTED CONFLICT ATTORNEY CLAIM FORM AND ORDER & ITEMIZED STATEMENT-(Rev. 01/16/2024)-FIN-31 FOR MANDATORY USE

ITEMIZED STATEMENT

CASE NO.:

SERVICE DATE TYPE OF SERVICE # OF HOURS RATE COST

TOTAL # OF HOURS X $ /HOUR= $

SIGN

Date Signature

COURT APPOINTED CONFLICT ATTORNEY CLAIM FORM AND ORDER & ITEMIZED STATEMENT-(Rev. 01/16/2024)-FIN-31 FOR MANDATORY USE