Free CJA 20 - Appointment - District Court of Arizona - Arizona

CIA zu APPOINTMENT OF AND AUTHORITY T0 PAY COURT APPOINTED COUNSEL "
1. CIR.ID1ST.IDIV. CODE 2. PERSON REPRESENTED VOUCH¥ · ~· = F ° ....._ LODGE '
AZX Harris, Tyrone Charles I FIECEIV C D • •
s. MAC. DI<.T.rD EF. NUMBER 4. DIST. DKTJDEF. NUMBER S. APPEALS DKTJDEF. NUMBER 6. OTHER DKT. NUMBER
&2:O4—OO105S-002 FIM s . . q.
r. IN CASEIMATTER OF {cse Nam) B. PAYMENT CATEGORY 9. TYPE PERSON REPRESENTED 10. lgzgléwma nn ) I · E
U.S. v. Hams Felony Adult Defendant L_E§I&itUi@b ·=·=·g . :
11. OFFENSE[S) CHARGED (Cite U.S. Code, Title & Section} lfmore than one offense, litt [up to Eve} major offenses charged, acco ing to ·
1) 18 924C.F -— VIOLENT CRIME/DRUGSf1\/[ACI·III*JE GUN BY _ _ y J 5EpU
`I2. A’I"[`ORNEY'S NA]VIEé-éFirst Name, MJ., Last Name, Including any suflix) 13. COURT ORDER
AND MAILING ADD SS E O Appointing Counsel [I C Co-Counsel
I] F Subs For Federal Defender [1 R Subs For_Retaiued Attorney
2 ’ E P Subs For Panel Attorney [I Y Standby Counsel
Ba-Saline Road Prior Attorney's Name:
G11beTt AZ 85233-1545 APP°‘“‘*"°*“ ""** --——————————
I] Because the above-named person represented has testified under oath or has
otherwise satisfied this court that he or she {1} is linanclally unable to employ counsel and
Telephone Numb": I (2) does not wish to waive counsel, and because the interests ofjustlce so require, the
attorney whose name appears ln Item 11 IS appointed to represent this person In this case,
I4. NA]\'I.E AND MAILING ADDRESS OF LAW FIRM [only provide per instructions) or
ANNE M. WELIAMS PC U °"'°i iiggmgjmij M E E I Q 3 E E
§6ga'Sclin€ Road Signature of Presiding Judicial Officer or By rder of the Court
. · MM?
GIIbC1`I AZ 3 -1 _ Dole of Order Nun: Pro Tune Date
A Repayment or partial repayment ordered from the person repruenteal for this service at
` time of appointnient. I] YES EI NO _
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1s. CERTIFICATION OF ATTORNEYIPAYEE FOR THE PERIOD OF SERVICE 10. APPOINTMENT 1·EmvnNA1·IoN DATE 21. CASE DISPOSITION
IF ornmz THAN CASE comrasrron
FROM T0 _______
22. CLAIM STATUS I] Final Payment [I Interim Payment Number _________ I] Supplementa1Pay1nent
Have you previously applied to the court for compensation slltlfor lulllllbunement for this ease? EI YES [I N0 Ifyes, were you paid? I] YES [I NO
Other than from the court. have yo · , or to your knowledge hu anyone else, received payment (cornpuuation or anything or value] from any other source in connection with this
representation? Ei YES EI N0 Ifyea, give details on additional sheets.
- I swear or affirm the truth or correctness of the above Statements. ‘
Signature of Attorney: Date:
za. PN COURT COMP. 24. OUT OF COURT COMP. zs. TRAVEL EXPENSES 26. OTHER EXPENSES 21. ron-Ar. AMT. APPR: ccnr
za. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER DATE ras. JUDGE : MAG. woes cons
29. IN COURT COMP. so. OUT OF COURT COMP. 31. TRAVEL EXPENSES S2. OTHER EXPENSES ss. TOTAL AMT. AITROVED
S4. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE) Payment DATE 1-Is. JUDGE CODE
approved in excess ofthe statutory threshold amount.
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Case 2:04-cr-01058-FJM

Document 63

Filed 12/12/2005

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