Authorization Payment Form

I. Case Information

Case Number: for Repr. of: Court: District County

Case Name: Number of Persons Represented: County:

Appointing Judge/Magistrate: Current Judge/Magistrate:

II. Appointee Information

Atty. Reg. No. Check if new address

Name: Address: City: State: Zip:

Phone: Fax: Email:

Appointment Date: Original appointee Substitute appointee Case has has not gone to trial.

Originally flat fee contract appointment. Reason for hourly bill: on (date).

III. Appointment Type

Counsel

Attorney GAL (Adult Representation Only)

Attorney - Child Family Inv. (CFI)

Non-Attorney - Child Family Inv. (CFI)

Investigator

Court Visitor

IV. Appointment Authority

Title 14 DOMESTIC REL. CHILD(REN) State pays for % ADVISORY COUNSEL

Title 15 PROBATE CRCP 107 CONTEMPT

Title 19 D & N RESPONDENT PARENT WITNESS (CJD 04-04)

Title 19 D & N SPECIAL RESPONDENT 13-90-208 WAIVER OF HEARING INTERP.

Title 19 PATERNITY/SUPPORT Title 27 MENTAL HEALTH

Title 22 EDUCATION CODE (Truancy)

Title 25 DRUG/ALC. COMMIT.

OTHER

V. Indigence

Responsible party(ies) determined to be indigent on (mm/dd/yy).

Indigence cannot be determined. Reason:

VI. Summary of billed activities

Occurring on or after July 1, 2018, from to

Expenses

Mileage Travel: (miles) x .49

Copies Number of copies: x .10

Miscellaneous Postage $ Long Distance $ Other: (explain) $

(Attach itemized receipts if over $50.00)

Total Request $

Total Amount Previously billed $ Total of Requests Exceed Allowed Maximum for appointment. Motion and Order for Excess Fees was granted and is attached.

The information provided in this request is true and accurate. No compensation for the services described has been received. A detailed itemization of the in-court and out-of-court hours is attached. I have reviewed “Court Appointee Procedures for Payment of Fees and Expenses” in Chief Justice Directive 04-04 or 04-05 and understand that payment may be adjusted for items that do not comply with the Department’s procedures. All court appointees and investigators must submit their JDF 207 (or invoice using CACS, as applicable) to the court within six months of the earliest date of billed activity. This form is for billing activities occurring on or after July 1, 2018. Contact cacpayments@judicial.state.co.us for JDF 207 prior to July 1, 2018.

Court Personnel Only

Request has been reviewed by district staff for accuracy and completeness, and payment is approved (with adjustments as indicated, if any).

Net Adjustment (+/-) $ Reason for adjustment (if not otherwise noted above)

Reimbursement was ordered and entered in CAC On-line System when Appointment was entered.

Court Staff Verified that appointment was created in CAC On-line System (to enable appointee to be paid)

Instructions

1. Hourly Rates Hourly rates are paid in accordance with the applicable Chief Justice Directive (i.e. 04-04, 04-05) or Chief Justice Order.

2. Maximum Fees The maximum total fees authorized per appointment as established in Chief Justice Directive 04-05 are as follows:

Title 19 – Dependency and Neglect Matters: Respondent Parent Counsel $3,532; CFI (attorney & non-attorney) $1,536; GAL or CFI (attorney & non-attorney) $1,536; Court Visitor $614.

Titles 14 and 15: Counsel (probate only) $3,532; GAL (attorney) $3,532; GAL or CFI (attorney & non-attorney) $1,536.

Title 19 – Other Matters (i.e. support, adoption, paternity, etc.): Paternity/Support counsel $1,232; CFI (attorney & non-attorneys) $1,536.

Titles 22, 25 and 27: Counsel $923; GAL (attorney) for adult $923.

Appeals: Counsel / GAL (attorney) for adult $3,532; CFI (attorney & non-attorney) $1,536.

For maximum total fees for counsel in criminal cases, refer to Attachment D (2) of Chief Justice Directive 04-04. If the total payment request for an appointment exceeds the maximum fee, a Motion for Fees in Excess must be submitted to the court and granted pursuant to Chief Justice Directives 04-04 and 04-05.

3. Reimbursable Expenses Allowable expenses are detailed in Attachment E (Guidelines for Itemized Hourly Payment) of Chief Justice Directive 04-04 and 04-05. All items must be detailed, itemized, and legible. If a charge exceeds $50.00, a receipt must be attached.

4. I.R.S. W-9 Form and “Authorization to Pay Law firm for Attorney Appointments” JDF 5 Form A completed W-9 form containing the appointee’s Tax Identification Number (Social Security Number or Federal Employer Tax Identification Number) must be on file with the State Court Administrator’s Office before payments will be processed. Those appointees wishing to have payments made to a law firm instead of to the appointee personally must complete the authorization form.

5. Instructions for Completion and Submission of JDF 207 Form Section VI shall be used to enter time and expenses. Submit two completed copies, along with detailed itemizations of hours and expenses for the billing period.

Sample Detail of Time and Expenses