(PLEASE TYPE OR PRINT LEGIBLY) CHECK HERE IF NEW ADDRESS
CLAIM OF ________________________________________________________ BAR NO. _____________________
ADDRESS ______________________________________________________________________________________
CITY, STATE _________________________________________________________ ZIP ______________________
E-MAIL _________________________________________________ PHONE ________________________________
DOCUMENT ID:
DOCUMENT TOTAL
$
COMMENTS (96)
(24)
(24)
(24)
(24)
VENDOR CODE
SAN BERNARDINO COUNTY
SUPERIOR COURT
Page _____ of _____
APPOINTED ATTORNEY FEES
CLAIM TOTAL $
The Auditor/Controller of the County of San Bernardino is hereby directed to issue a
warrant in the amount of $____________________ in payment of attorney fees and
costs to the above-named declarant.
I certify that the above services were directed by the appropriate authority and verified in accordance with established
procedures.
13-17714-360 Rev. 7/11
APPROVAL FOR PAYMENT: I hereby certify that I have examined the facts
of the transaction herein set forth as evidenced by the information hereon and
documents attached hereto. All verifications, certification, and checking of
computations required by the Government Code have been complied with and
this claim in the total amount shown is hereby approved for payment.
CASE NO. _____________________________
CASE NAME ___________________________
CLIENT NAME _________________________
APPOINTMENT DATE ___________________
I hereby certify under penalty of perjury that the foregoing claim for services
is true and correct (CCP 2015.5), that I have been continually duly licensed to
practice as an attorney in the State of California for the time period during which
the services claimed were rendered, that I was appointed pursuant to applicable
California Code to represent the named client, and that no part of this claim has
previously been presented or paid.
Judge Date
ADDITIONAL CLAIM FORMS AND THE COURT’S LOCAL RULES AND APPOINTED SERVICES FEE SCHEDULE ARE AVAILABLE ON THE COURT’S WEBSITE: www.sb-court.org
Family Law other than 3150 Minor’s Counsel,
Civil, Guardianship, Probate/Conservatorship Cases
Declarant Date
CHECK TYPE OF APPOINTMENT: Family Law other than 3150 Minor’s Counsel; Civil; Guardianship; Probate/Conservatorship; Other (specify): ______________________________
All Fees per Local Rules of Court Chapter 14 — All claims for attorney fees must be submitted within sixty (60) days of completion of case per Local Rule of Court 1414.
Note:
*
Billing must comply with Court’s Appointed Services Fee Schedule. Attach additional pages with itemized detail by date and time as required. DATE(S)* AMOUNT
Appointment Fee (includes conferences, preparation and appearances except as specifically authorized)
*
...................................................... ______________ $ _______________
Written motions and/or evidentiary hearings, collectively on a complaint and not to exceed 3 hours
*
........................................................... ______________ $ _______________
Trial (full day/half day) on civil or family law complaint
*
............................................................................................... ______________ $ _______________
Additional court appearances not for convenience of appointed attorney
*
................................................................................ ______________ $ _______________
Preparation and appearances regarding stipulated agreements
*
....................................................................................... ______________ $ _______________
Out-of-court time reasonably expended at Court discretion if specifically authorized.
*
Attach additional pages with itemized detail .................................... ______________ $ _______________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Special expense(s) at Court discretion and pursuant to Local Rule of Court 1415 (original receipts required): ..................................................................... $ _______________
Approving Authority Date
COUNTY
AUDITOR/CONTROLLER BY _________________________________________________________________ DATE________________________
PV
___ ___ ____________________________
TRANS DEPT. PV NUMBER
LINE NO.
FUND DEPT ORGANIZATION APPR OBJECT GRC/PROJ/JOB NUMBER AMOUNT
LINE NO.
FUND DEPT ORGANIZATION APPR OBJECT GRC/PROJ/JOB NUMBER AMOUNT
LINE NO.
FUND DEPT ORGANIZATION APPR OBJECT GRC/PROJ/JOB NUMBER AMOUNT
200 2 4 4 0
200 2 4 4 0
200 2 4 4 0
Verifying Official Date
