CJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT-APPOINTED COUNSEL (Rev. 07/17)
1. CIR./DIST./ DIV. CODE 2. PERSON REPRESENTED VOUCHER NUMBER
3. MAG. DKT./DEF. NUMBER 4. DIST. DKT./DEF. NUMBER 5. APPEALS DKT./DEF. NUMBER 6. OTHER DKT. NUMBER
7. IN CASE/MATTER OF (Case Name) 8. PAYMENT CATEGORY 9. TYPE PERSON REPRESENTED 10. REPRESENTATION TYPE
G
Felony
G
Petty Offense
G
Adult Defendant
G
Appellant
(See Instructions)
G
Misdemeanor
G
Other
G
Juvenile Defendant
G
Appellee
G
Appeal
G
Other
11. 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.
12. ATTORNEY’S NAME (First Name, M.I., Last Name, including any suffix), 13. COURT ORDER
AND MAILING ADDRESS
G O Appointing Counsel G C Co-Counsel
G F Subs For Federal Defender G R Subs For Retained Attorney
G P Subs For Panel Attorney G Y Standby Counsel
Prior Attorney’s
Appointment Dates:
G
Because the above-named person represented has testified under oath or has otherwise
Telephone Number :
satisfied this Court that he or she (1) is financially unable to employ counsel and (2) does
not wish to waive counsel, and because the interests of justice so require, the attorney whose
name appears in Item 12 is appointed to represent this person in this case, OR
14. NAME AND MAILING ADDRESS OF LAW FIRM (Only provide per instructions)
G
Other (See Instructions)
Signature of Presiding Judge or By Order of the Court
Date of Order Nunc Pro Tunc Date
Repayment or partial repayment ordered from the person represented for this service at time
appointment.
G
YES
G
NO
CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY
CATEGORIES (Attach itemization of services with dates)
HOURS
CLAIMED
TOTAL
AMOUNT
CLAIMED
MATH/TECH.
ADJUSTED
HOURS
MATH/TECH.
ADJUSTED
AMOUNT
ADDITIONAL
REVIEW
15. a. Arraignment and/or Plea
In Court
b. Bail and Detention Hearings
c. Motion Hearings
d. Trial
e. Sentencing Hearings
f. Revocation Hearings
g. Appeals Court
h. Other (Specify on additional sheets)
(RATE PER HOUR = $
)
TOTALS:
16. a. Interviews and Conferences
Out of Court
b. Obtaining and reviewing records
c. Legal research and brief writing
d. Travel time
e. Investigative and other work (Specify on additional sheets)
(RATE PER HOUR = $
)
TOTALS:
17. Travel Expenses (lodging, parking, meals, mileage, etc.)
18. Other Expenses (other than expert, transcripts, etc.)
GRAND TOTALS (CLAIMED AND ADJUSTED):
19. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE 20. APPOINTMENT TERMINATION DATE
IF OTHER THAN CASE COMPLETION
21. CASE DISPOSITION
FROM:
TO:
22. CLAIM STATUS G Final Payment G Interim Payment Number G Supplemental Payment
Have you previously applied to the court for compensation and/or reimbursement for this case? G YES G NO If yes, were you paid? G YES G NO
Other than from the Court, have you, or to your knowledge has anyone else, received payment (compensation or anything of value) from any other source in connection with this
representation? G YES G NO If yes, give details on additional sheets.
I swear or affirm the truth or correctness of the above statements.
Signature of Attorney Date
APPROVED FOR PAYMENT — COURT USE ONLY
23. IN COURT COMP. 24. OUT OF COURT COMP. 25. TRAVEL EXPENSES 26. OTHER EXPENSES 27. TOTAL AMT. APPR./CERT.
28. SIGNATURE OF THE PRESIDING JUDGE DATE 28a. JUDGE CODE
29. IN COURT COMP. 30. OUT OF COURT COMP. 31. TRAVEL EXPENSES 32. OTHER EXPENSES 33. TOTAL AMT. APPROVED
34. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE) Payment approved DATE 34a. JUDGE CODE
in excess of the statutory threshold amount.
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