San Bernardino — SB-17710

Source: https://sanbernardino.courts.ca.gov/system/files/forms-filing/sb-17710.pdf

Superior Court of California, County of San Bernardino INTERPRETER SERVICES CLAIM

INTERPRETER NAME: CERTIFICATION/REGISTRATION # COURT SITE CODES CLAIM PAYABLE TO: 1 San Bernardino (SBJC) 7 Fontana CHECK ONE ADDRESS*: JUDICIAL COUNCIL CERTIFIED/REGISTERED 2 San Bernardino (Historic) 8 Juvenile (San Bernardino) 3 Rancho Cucamonga 9 Child Support (San Bernardino) CITY/STATE: ZIP: NON-JUDICIAL COUNCIL CERTIFIED/REGISTERED 4 Victorville 10 Mental Health 5 Barstow 11 Big Bear FID/SS NO.: PHONE: LANGUAGE 6 Joshua Tree 12 Needles

Check here if new address PER DIEM MILEAGE CASE TYPE REQUIRED Mileage Rate $0.76 COURT SITE CODE CASE NUMBER (see table CASE NAME DATE OF SERVICE (see table above) below) Half Day Full Day Total Fee Miles Mileage total @ Total Per Diem & Mileage (mark box) (mark box) $0.76/mile

$ - $ -

$ - $ -

$ - $ -

$ - $ -

*Interpreter address if different from above: TOTAL CLAIM $ -

CLAIMANT STATEMENT: The foregoing claim for services is true and correct. I understand that while serving as an CASE TYPES interpreter in San Bernardino County Superior Courts, I am obligated to interpret in any court and/or District as needed CH Civil Harassment DV Domestic Violence FT Family (Termination of Parental Rights) PO Probate (other) without payment in addition to the summoning Court's applicable fee schedule. I hereby certify that no request for CO Civil (other) EA Elder/Dependent Adult Abuse I Infraction PA Public Assistance additional payment has been or will be made. DP Dependency F Felony M Misdemeanor T Traffic "I certify (or declare) under penalty of perjury that the foregoing is true and correct": DQ Delinquency FC Family (Child Support) MH Mental Health UD Unlawful Detainer X X X DR Drug Court FO Family (other) PG Probate (Guardianship/Conservatorship) O Other (specify) Date Place (city or county) Claimant Signature COURT USE ONLY BELOW THIS LINE

APPROVAL FOR PAYMENT: I have examined the facts of the transaction set forth herein and the documents COORDINATOR STATEMENT: The services reported were necessary, directed by the appropriate authority, verified in accordance with attached hereto. All verifications, certification, and checking of computations required by the Trial Court Financial established procedures and rendered as set forth above. Policies and Procedures manual have been complied with and this claim is in the total amount shown and it is hereby approved for payment. "I certify (or declare) under penalty of perjury that the foregoing is true and correct": "I certify (or declare) under penalty of perjury that the foregoing is true and correct":

in San Bernardino County X in San Bernardino County X
Date Approved by (signature) Date Verifying Coordinator Signature

in San Bernardino County
Date Posted by (initials) DOCUMENT ID:

DOCUMENT TOTAL: VENDOR CODE: $ G/L ACCT ORDER CODE Cost/Fund Center WBS Element Func.PECTarea FUND AMOUNTS

LINE 1: 1320

LINE 2: 1320

LINE 3: 1320
LINE 4: 1320
Original: Court Photocopy: Claimant Form No. SB-17710 Rev. 7/1/2026