Free Retired Judge Voucher for Services as Special Judge - Kentucky

AOC-SJ-20 Rev. 2-09 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov

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Retired Judge Voucher for Services as Special Judge

Remit To: Supreme Court of Kentucky 700 Capitol Avenue Room 235 Frankfort, Kentucky 40601-3415

SPECIAL JUDGE PRINTED NAME: Court Level:

_______________________________________________ _______________________________________________

Pursuant to KRS 26A.015, 26A.020, and 21A.110, reimbursement is requested as follows: 1. Total Compensation* claimed: Daily compensation rate of $__________ x number of days served ____ = List dates of service: ______________________________________________ _______________________________________________________________ *Compensation is authorized only in instances in which a retired justice or judge is designated to serve by the Chief Justice. Compensation is computed pursuant to KRS 21A.110. The salary for each day the justice or judge serves shall be the difference, if any, between 1/250 of the annual retirement benefits and 1/250 of the annual salary for the judicial office in which he/she performs the judicial duties. No special judge shall receive compensation that is less than $150 per day.

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$ ____________

2.

Total Personal Expenses claimed: (Includes meals, travel, lodging, etc.) Attach AOC-T Travel Voucher form and personal receipts.

$ ____________

3.

Grand Total Claimed:

$ ____________

DATE: ____________, 2________

___________________________________________ Retired Judge (serving as Special Judge)

APPROVED FOR PAYMENT DATE: ____________, 2_____. _____________________________________ CHIEF JUSTICE

Note: Compensation will be payable through the AOC Human Resources Division as wages. There will be tax
and fica withholdings withheld on the compensation amount approved. The special judge will receive a W-2 IRS form upon calendar year end. Personal expenses are payable through the AOC Accounting Division.

AOC ­ SJ - 20 Rev. 2-09 Page 2 of 2

PERSONAL INFORMATION:
LEGAL PRINTED NAME: ____________________________________________________ ADDRESS: _____________________________________________________________ _____________________________________________________________ PHONE NO: ( ) ________________ DATE OF BIRTH: ________________

SOCIAL SECURITY NO. OR STATE EMPLOYEE ID NO. _______-________-__________

The gender and race information is gathered voluntarily for statistical purposes only:

Gender: (circle one) Race: (circle one)

Male White

Female Black or African American Hispanic or Latino Two or more races Asian Other ________________________

American Indian or Alaskan Native Native Hawaiian or other Pacific Islander

Compensation will be payable through the AOC Human Resources Division as wages. There will be tax and fica withholdings withheld on the compensation amount approved. The special judge is responsible for updating or submitting W-4 and K-4 federal and state employee withholding allowance certificates. If the W-4 or K-4 is not provided with this voucher, the allowances will be set to a default of single and 0 number of allowances/exemptions.
Occupational Local Tax: (please choose one below)

____ I will pay occupational tax through payroll deduction. County/Counties; % each ______________________________________

____ I do not want occupational tax deducted from my payroll check. I will be responsible for making payment arrangements to the city/county.

Remit To:

Supreme Court of Kentucky 700 Capitol Avenue Room 235 Frankfort, Kentucky 40601-3415

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