Free Costs and Expenses - Oregon

STATE OF OREGON
Appellate Court Case Number(s):

9 Supreme Court 9 Court of Appeals
COURT-APPOINTED COUNSEL REQUEST FOR CERTIFICATION OF COMPENSATION, COSTS AND EXPENSES V.
Plaintiff Defendant

TRIAL COURT: 1.

Circuit Court of County APPOINTMENT INFORMATION:

9

District Court

9

Trial Court Case No(s):

Client is: Appellant/Petitioner Respondent Name of Client: Appointed Counsel: OSB No: Date Appointed: ORS Authority for Appointment: 2. CASE INFORMATION: ORS Appointment Type: Date Argued/Submitted: Convictions

9

9

Counsel Vendor No: Counsel Tax ID No: Mailing Address:

Death penalty cases only-billing: Final Not Final SC Disposition: If not final, what further service expected? 3. COMPENSATION, COSTS AND EXPENSES REQUESTED: Hours Worked by .10 hours Rate $ A. ATTORNEY TIME (ATOA Quantity/Units B. COSTS AND EXPENSES $ $ $ $ $ LIST ATTACHED; SUBTOTAL ALL COSTS AND EXPENSES C. TOTAL COMPENSATION, COSTS AND EXPENSES (A plus B)

9 9

CA Disposition: on reconsideration:

Date: Date: Date:

Amount Requested $ $ $ $ $ $ $ $

FOR COURT USE ONLY Court-Approved Amount*

$ $ $ $ $ $ $ $

9

I certify that the information in this request for certification, including any attachments, is true. I have not been promised, have not received and will not accept direct or indirect compensation for these services except as approved by the court or authorized by contract under ORS 151.460.
DATE SIGNATURE OF COUNSEL

CERTIFICATION OF COMPENSATION, COSTS AND EXPENSES An order having been entered appointing counsel on the basis of a determination that the person for whom counsel was * is reasonable and necessary as compensation, costs and appointed is indigent, the court certifies that $ expenses and is properly payable out of state indigent defense funds.

DATE

JUDGE

JUDGES OSB NUMBER

PRINT, TYPE OR STAMP NAME OF JUDGE

*IF THE AMOUNT APPROVED IS LESS THAN THE AMOUNT REQUESTED, SEE THE ATTACHED NOTICE OF DISALLOWED COMPENSATION, COSTS AND EXPENSES. PTCF SUP/COA-100:10/9: 1-COURT APPOINTED COUNSEL REQUEST FOR CERTIFICATION OF COMPENSATION, COSTS AND EXPENSES

EVT