Fillable SB 17710 SB 17710 (Superior Court of California)

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SB 17710 SB 17710 (Superior Court of California)

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PHONE:
Check here if new address
Mileage Rate $0.575
Half Day
(mark box)
Full Day
(mark box)
*Interpreter address if different from above:
X
X X
Date
in San Bernardino County X
Date
Date
VENDOR CODE:
-$
-$
LINE 4:
Form No. SB-17710 Rev. 1/1/2020
Original: Court Photocopy: Claimant
LINE 1:
LINE 3:
LINE 2:
DOCUMENT TOTAL:
$
FUND
ORDER CODE
G/L ACCT
DOCUMENT ID:
Approved by (signature)
X
Verifying Coordinator Signature
in San Bernardino County
COORDINATOR STATEMENT: The services reported were necessary, directed by the appropriate authority, verified in accordance with
established procedures and rendered as set forth above.
"I certify (or declare) under penalty of perjury that the foregoing is true and correct":
Date
COURT USE ONLY BELOW THIS LINE
APPROVAL FOR PAYMENT: I have examined the facts of the transaction set forth herein and the documents
attached hereto. All verifications, certification, and checking of computations required by the Trial Court Financial
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":
in San Bernardino County
Cost/Fund Center
AMOUNTS
CITY/STATE:
FID/SS NO.:
CASE TYPE
(see table
below)
CASE NAME
Miles
Superior Court of California, County of San Bernardino
INTERPRETER SERVICES CLAIM
ZIP:
CERTIFICATION/REGISTRATION #
REQUIRED
ADDRESS*:
COURT SITE CODE
(see table above)
CASE NUMBER
DATE OF SERVICE
PER DIEM
Total Fee
CHECK ONE
JUDICIAL COUNCIL CERTIFIED/REGISTERED
NON-JUDICIAL COUNCIL CERTIFIED/REGISTERED
LANGUAGE
INTERPRETER NAME:
CLAIM PAYABLE TO:
MILEAGE (paid for actual miles driven above 60 miles)
Mileage total @
$0.575/mile
Total Per Diem & Mileage
-$
-$
-$
Claimant Signature
TOTAL CLAIM
CLAIMANT STATEMENT: The foregoing claim for services is true and correct. I understand that while serving as an
interpreter in San Bernardino County Superior Courts, I am obligated to interpret in any court and/or District as needed
without payment in addition to the summoning Court's applicable fee schedule. I hereby certify that no request for
additional payment has been or will be made.
"I certify (or declare) under penalty of perjury that the foregoing is true and correct":
Place (city or county)
-$
-$
-$
-$
Func. area
PECT
1320
1320
1320
1320
WBS Element
CH Civil Harassment DV Domestic Violence FT Family (Termination of Parental Rights)
CO Civil (other) EA Elder/Dependent Adult Abuse I Infraction
DP Dependency F Felony M Misdemeanor
DQ Delinquency FC Family (Child Support) MH Mental Health
DR Drug Court FO Family (other)
PG Probate (Guardianship/Conservatorship)
T Traffic
UD Unlawful Detainer
O Other (specify)
CASE TYPES
PO Probate (other)
PA Public Assistance
COURT SITE CODES
1 San Bernardino (SBJC) 7 Fontana
2 San Bernardino (Historic) 8 Juvenile (San Bernardino)
3 Rancho Cucamonga 9 Child Support (San Bernardino)
4 Victorville 10 Mental Health
5 Barstow 11 Big Bear
6 Joshua Tree 12 Needles
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SB 17710 SB 17710 (Superior Court of California)

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Completed 23 July 2020

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