Fill and Sign the For Work Performed Before 61099

State of Alabama Unified Judicial System Form C-62A Rev .11/07 ATTORNEY’S FE E DECLARATION (Adult) [For Work Performed Before 6/10/99] County Code __ __ Case Number _ _ _ _ _ _ _ _ _ _ _ _ _ Jurisdiction Year Case# Suffix Mark Appropriate Court: Attorney Name (Please type or print) … Circuit Court of _________________ County … District Court of_________________ County ___________________________________________ … Municipal Court of_______________ … Alabama Court of Criminal Appeals ___________________________________________ … Supreme Court of Alabama Social Security Number or FEIN Indicate If: Capital Case _____ (CC) Other ___ (NC) STYLE OF CASE: STATE OF ALABAMA _ _______________________________________________________________________________ Defendant CHARGE: _________________________________________________________________________________________________________ Companion case numbers and charges or convictions: ______________________________________________________________________ __________________________________________________________________________________________________________________ The undersigned attorney declares that on (date) _______________________________________, the Honorable _______________________ _______ _______________________, Judge, appointed the undersigned to represent the above-named defendant or appellant, and on (date) __ _____________ the case was heard by the Honorable _____________________________________________________________, Judge. The case was disposed of by __________________________________________________________________________________________________________________ (Plea of guilty, conviction, acquittal, affirmance, reversal, cert. denied) (1) In Court Appearance Total Hours __________ x $ 40.00 per hour = ___________________ (2) Out of Court Preparation (Trial Level) Total Hours __________ x $ 20.00 per hour = ___________________ (3) Out of Court Preparation (Appellate Level) Total Hours __________ x $ 40.00 per hour = ___________________ (4) Extraordinary Expenses (If approved in advance by court) _______________________________________________\ __________ (5) Overhead Expenses 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 pr eparation; (3) extraordinary expenses reflecting the date of actions and amount of time 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 rendered by him/her as an attorney and the amount is due and payable. I further declare that the above claim 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 h ave reviewed the same and believe 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, Ala. Code 1975, provi de for the payment of attorney fees and extraordinary expenses incurred by counsel appointed to represent indigent defendants at the trial lev el on appeal (including petition for writ of certiorari to the Alabama Supreme Cour t) and in post-conviction proceedings. THIS FORM MUST CONTAIN ORIGINAL SIGNAT URES OF THE ATTORNEY AND THE JUDGE. THIS FORM WITH ATTACHED ITEMIZATION MUST BE SUBMITTED TO THE TRIAL COURT JUDGE OR PRESIDING JUDGE OR CHIEF JUSTICE OF THE APPELLATE COURT FOR APPROVAL. AFTER APPROVAL, FILE WITH THE CLERK, WHO SHALL SUBMIT THE ORIGINAL DECLARATION TO THE STATE COMPTROLLER (EXCEPT IN MUNICIPAL CASES) FOR AUDIT. EXCEPT IN MUNICIPAL CASES, MAIL TO: State Comptroller, Indigent Defense Section, P.O. BOX 302602, Montgomery, Alabama 36130-2 602.