Fill and Sign the Form C 62a Rev

ATTORNEY’S FEE DECLARATION (Adult) [For Work Performed On or After _________]State of Alabama Unified Judicial System Form C-62A Rev. 7/2000 Case Number Jurisdiction Year Case Suffix County Code NOTICE TO ATTORNEY AND JUDGE: Sections 15-12-21 through 15-12-23, Code of Alabama 1975, provide for the payment of fees and extraordinary expenses incurred by counsel appointed to represent indigent defendants at the trial level, on appeal (including petition for writ of certiorari to the Alabama Supreme Court) and in post-conviction proceedings. THIS FORM MUST CONTAIN ORIGINAL SIGNATURES OF THE ATTORNEY AND THE JUDGE. THIS FORM WITH ATTACHED ITEMIZATION MUST BE SUBMITTED TO THE TRIAL 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. Filed in the Clerk’s Office at , Alabama, on (Date) EXCEPT IN MUNICIPAL CASES, MAIL TO: State Comptroller, Indigent Defense Section, P. O. Box 302602, Montgomery, Alabama 36130-2602 I, the undersigned judge, hereby certify that the foregoing claim has been presented to me, and I have 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 (companion or otherwise). Based on the above, I hereby approve the declaration and claim in the amount of $ Done this the day of , . Judge’s Signature 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 said 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 otherwise). Signature of Attorney Attorney Code Mailing Address of Attorney (please type / print; including city, state, and zip code Sworn to and subscribed before me this day of , Notary Public Telephone Number Fax Number (1) In-Court Appearance (Trial Level or Post Conviction Proceeding) Total Hours x$ 60.00 per hour = $ (2) Out-of-Court Preparation (Trial Level or Post Conviction Proceeding) Total Hours x$ 40.00 per hour= $ (3) Preparation (Appellate Level) Total Hours x$ 60.00 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 appearances; (2) out-of-court preparation; (3) preparation for appeals; (4) extraordinary expenses; and (5) overhead expenses reflecting the date of actions and amount of time involved in each activity. Make a copy of the same for the court’s record and a copy for your records. STYLE OF CASE:  STATE OF ALABAMA  MUNICIPALITY OF V. 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) Attorney Name (Please type or print) Social Security Number or FEIN Mark Appropriate Court: Indicate if Original Charge is: Limits  Circuit Court of _____________ County Capital Case (or charge  District Court of County carrying sentence of  Municipal Court of life without parole)  (No Limit ) CC Alabama Court of Criminal Appeals Class A Felony  ($3,500) FA  Alabama Court of Civil AppealsClass B Felony  ($2,500) FB  Supreme Court of AlabamaClass C Felony ($1,500) FC Other ($1,000) OT Appeal ($2,000) AP Petition for Writ of Certiorari ($2,000) WC Post-Conviction/Habeas Corpus ($1,000) PC