(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
SUPERIOR COURT OF CALIFORNIA
COUNTY OF SAN BERNARDINO
Page _____ of _____
APPOINTED ATTORNEY FEES
CLAIM TOTAL $
The Superior Court of California, 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.
12-21282-356 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
Dependency Cases and Family Law 3150 Minor’s Counsel
Declarant Date
CHECK TYPE OF APPOINTMENT: Dependency; Family Law Code 3150 Minor’s Counsel
**
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 Service Fee Schedule. Attach additional pages with itemized detail by date and time as required.
**
Claims for Family Law cases must be submitted monthly per Local Rule of Court 1417. DATE(S)* AMOUNT
Appointment Fee (includes entry of plea, conferences, cases preparation and appearances)
*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.
*
Attach additional pages with itemized detail by date and time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________ $ ______________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Special expense(s) at Court discretion and pursuant to Local Rule of Court 1415 (original receipts required): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ______________
APPROVED / PARKED BY ______________________________________________________ DATE _______________________
Verifying Official Date
APPROVED / PARKED BY ______________________________________________________ DATE _______________________
LINE 1:
LINE 2:
LINE 3:
LINE 4:
G/L ACCT COST/FUND CENTER Functional Area PECT FUND AMOUNTS
$
$
$
$
