Fill and Sign the For Work Performed 61099 through 93000

State of Alabama Unified Judicial System Form C-62B Rev. 11/07 ATTORNEY’S FEE DECLARATION (Juvenile) [For Work Performed 6/10/99 through 9/30/00] County Code __ __ Case Number _ _ _ _ _ _ _ _ _ _ _ _ _ Jurisdiction Year Case# Suffix IN THE JUVENILE COURT Attorney Name (Please Type or print) OF ____________________________ COUNTY ________________________________________________________ In the matter of juvenile case number above ________________________________________________________ Social Security Number of FEIN Appeal to the court of: Type of Case … Alabama Court of Criminal Appeals … Delinquency … Alabama Court of Civil Appeals … Dependency … Supreme Court of Alabama … In Need of Supervision … Other (Describe) ____________________________________________ The undersigned attorney declares that on (date) __________________________________, the Honorable ____________________________ _______ ______________________________________________________________________________, Judge, appointed the undersigned to represent the … child or … parent/guardian, and on (date) ___________________________________________________ the case was disposed of by ________________________________________ ____________________________________________________________________________ ________________________________________ ____________________________________________________________________________ (Adjudication of dependency, in need of supervision or delinquency, cert. denied, etc.) The undersigned attorney further declares that he/she has provided services in the case as attorney or guardian and litem and m akes the following claims for such services: (1) In court Appearance (Trial Level or Post-Conviction Proceeding) Total Hours __________ x $ 50.00 per hour = ___________________ (2) Out-of-Court Preparation (Trial Level or Post-Conviction Proceeding) Total Hours __________ x $ 30.00 per hour = ___________________ (3) Preparation (Appellate Level) Total Hours __________ x $ 50.00 per hour = ___________________ (4) Extraordinary Expenses (If approved in advance by court) _______________________________________________\ __________ (5) Overhead Expenses (If approved in advance by court) Total Hours __________ x $ ____ Per hour = _________________ __ TOTAL CLAIM OF ATTORNEY _______________________________ NOTICE TO ATTORNEY: Complete this form. Attach a copy of a complete itemization of (1) in-court appearance; (2) out-of-court preparation; (3) preparation for appeals;(4) extraordinary expenses; and/or (5)overhead expenses reflecting the date of actions and amount of ti me involved in each activity. Make a copy of same for the court’s record and a copy for your records. The undersigned attorney further declares that the above claim is true and correct and represents the services actually rendere d by him/her as an attorney and the amount is due and payable. I further declare that the above clai m is not a duplication of charges and expenses in any case (companion or othe rwise) _________________________________________________________________ Signature of Attorney Attorney Code _____________________________________ Sworn to and subscribed before me this ____________ Mailing Address of Attorney (please type or print) (including city, state, and zip code) day of ___________________________, ___________ _________________________________________________________________ _________________________________________________________________ _____________________________________________ _________________________________________________________________ Notary Public Telephone Number _________________ Fax Number _________________ I, the undersigned judge, hereby certify that the foregoing claim has been presented to me, and I have reviewed the same and be lieve the same to be true and correct. I am further of the opinion that said attorney is not duplicating said charges and expenses in any case (comp anion or otherwise). Based on the above, I hereby approve the declaration and claim in the amount of $ ________________________________________ __________ Done this _______________ day of _______________________________, ___________. _________________________________________________________________ Judge’s Signature NOTICE TO ATTORNEY AND JUDGE: Sections 15-12-21 through 15-12-23, code of Alabama 1975, provide that fees and ex penses of court appointed attorney’s shall be paid by the State of Alabama. THIS FORM MUST CONTAIN ORIGIN AL SIGNATURES OF THE ATTORNEY AND THE JUDGE. THIS FORM WITH ATTACHED ITEMIZATION MUST BE SUBMITTED TO THE TRIAL COURT JUDGE OR PRESIDING JUDGE OR CHIEF JUST ICE OF THE APPELLATE COURT FOR APPROVAL. AFTER APPROVAL, FILE WITH THE CLERK, WHO SHAL L SUBMIT THE ORIGINAL DECLARATION TO THE STATE COMPTROLLER FOR AUDIT. MAIL TO: State Comptroller, Indigent Defense Section, P.O. BOX 302602, Montgomery, Alabama 36130-2602 . Filed in the Clerk’s Office at ______________________________ Alabama, on ___________________ dat e Original: Comptroller Yellow: Court File Pink: Attorney