Fill and Sign the Cja24 Authorization and Voucher for Payment of Transcript Form

OCJA 21 AUTHORIZATION AND VOUCHER FOR EXPERT AND OTHER SERVICES (Rev. 1/06) 1. CIR./DIST./ DIV. CODE 2. PERSON REPRESENTED VOUCHER NUMBER 3. MAG. DKT./DEF. NUMBER 4. DIST. DKT./DEF. NUMBE R 5. APPEALS DKT./DEF. NUMBER 6. OTHER DKT. NUMBER 7. IN CASE/MATTER OF (Case Name)8. PAYMENT CATEGORY 9. TYPE PERS ON REPRESENTED 10. REPRESENTATION TYPE G F elony G P etty Off ense G Adult Defe nd ant G App ell an t (See Ins tru cti ons) G M is d em ea no r G Ot her G Juv enile D efe nd ant G App ell ee G A pp eal G Ot her 11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense. REQUEST AND AUTHORIZATION FOR EXPERT SERVICES 12. ATTORNEY’S STATEMENT As the attorney for the person represented, who is named above, I hereby affirm that the services requested are necessary for adequate representation. I hereby request: G Authorization to obtain the service. Estimated Compensation and Expenses: ZOR G Approval of services already obtained to be paid for by the United States pursuant to the Criminal Justice Act. (Note: Prior authorization should be obtained for services in excess of $500, excluding expenses) Signature of Attorney Date G Panel Attorney GRetained Attorney GPro-Se GLegal Organization ATTORNEY’S NAME ( First Name, M.I., Last Name, including any suffix), AND MAILING ADDRESS Telephone Number: 13. DESCRIPTION OF AND JUSTIFICATION FOR SERVICES (See Instructions)14. TYPE OF SERVICE PROVIDER 01 GInvestigator 15 GOther Medical 02 GInterpreter/Translator 16 GVoice/Audio Analyst 03 GPsychologist 17 GHair/Fiber Expert 04 GPsychiatrist 18 GComputer (Hardware/ 15. COURT ORDER 05 GPolygraph Software/Systems) 06 GDocuments Examiner 19 GParalegal Services Financial eligibility of the person represented having been established to the Court’s satisfaction, the authorization requested in Item 12 is hereby granted. 07 GFingerprint Analyst 20 GLegal Analyst/Consultant 08 GAccountant 21 GJury Consultant 09 GCALR (Westlaw/Lexis, etc.) 22 GMitigation Specialist Signature of Presiding Judge or By Order of the Court 10 GChemist/Toxicologist 23 GDuplication Services 11 GBallistics (See Instructions) Date of Order Nunc Pro Tunc Date 13 GWeapons/Firearms/Explosive Expert 24 GOther (Specify) Repayment or partial repayment ordered from the person represented for this service at time of authorization. 14 GPathologist/Medical Examiner G YES GNO CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY 16. SERVICES AND EXPENSES (Attach itemization of services with dates) AMOUNT CLAIMEDMATH/TECHNICAL ADJUSTED AMOUNT ADDITIONAL REVIEW a. Compensation b. Travel Expenses (lodging, parking, meals, mileage, etc.) c. Other Expenses GRAND TOTALS (CLAIMED AND ADJUSTED): 17. PAYEE’S NAME AND MAILING ADDRESS TIN: Telephone Number: CLAIMANT’S CERTIFICATION FOR PERIOD OF SERVICE FROM TO CLAIM STATUS GFinal Payment GInterim Payment Number GSupplemental Payment I hereby certify that the above claim is for services rendered and is correct, and that I have not sought or received payment (compensation or anything of value) from any other source for these services. Signature of Claimant/Payee Date 18. CERTIFICATION OF ATTORNEY I hereby certify that the services were rendered for this case. Signature of Attorney Date APPROVED FOR PAYMENT — COURT USE ONLY 19. TOTAL COMPENSATION 20. TRAVEL EXPENSES 21. OTHER EXPENSES 22. TOTAL AMOUNT APPROVED/CERTIFIED 2 3 G Either the cost ( excluding expenses) of these se rvices does not exceed $ 500, or p rior autho rization was obtained. G Prior authorization was not obtai ned, but in the interest of justice the Court finds that timely procurement of these necessary services could not await pr ior authorization, even though the cost (excluding expenses) exceeds $500. Signature of Presiding Judge Date Judge Code 24. TOTAL COMPENSATION 25. TRAVEL EXPENSES 26. OTHER EXPENSES 27. TOTAL AMOUNT APPROVED 28. PAYMENT APPROVED IN EXCESS OF THE STATUTORY THRESHOLD UNDER 18 U.S.C. § 3006A(e)(3) Signature of Chief Judge, Court of Appeals (or Delegate) Date Judge Code $0.00 $0.00 $0.00 $0.00