Fill and Sign the Judicial Branch Colorado General Assembly Form

JDF 204 R8/04 MOTION AND ORDER TO PAY EXPERT WITNESS FEES AND EXPENSESCounty Court District Court Denver Juvenile Court Denver Probate Court _________________________________________ County, ColoradoCourt Address:Case Name: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division Courtroom MOTION AND ORDER TO PAY EXPERT WITNESS FEES AND EXPENSES I, __________________________________, move the Court for an order authorizing payment of the following expert witness fees and/or expenses, based on the attached itemized statement from the expert witness. Said fees were incurred pursuant to §13-33-102(4), C.R.S., in the above case and are reasonable for the services performed. Fees and compensation follow the policy and guidelines set forth in Chief Justice Directive 87-01.Expert’s Name, Degree/Certification, Address, and Social Security/or Federal Tax Identification number:Name: __________________________________________________ Degree/Certification: _______________Address: ________________________________________________ City/State/Zip: ____________________Social Security Number or Federal Tax Identification Number: _________________________________________(A completed W-9 form containing the payee’s Tax Identification Number (Social Security Number or Federal Employer Tax Identification Number) must be on file before a payment will be processed. If the payee has not previously received payment from the State of Colorado Judicial Department, a W-9 form must be completed, including the payee’s signature, and attached to this form along with required payment documentation as per CJD 87-01 guidelines. A W-9 form can be accessed and printed from the following web sites):http://www.irs.gov/pub/irs-fill/fw9.pdf or http://www.colorado.gov/dpa/dfp/sco/forms/substitute%20form%20w-9.pdfFees:Case preparation: Hourly rate $ ________ x ______ hours = $ ________________________ Testimony time Hourly rate $ ________ x ______ hours = $ ________________________ Time waiting to testify due to the scheduled appearance being delayed Hourly rate $ ________ x ______ hours = $ ________________________ Travel time Hourly rate $ ________ x ______ hours = $ ________________________ Total Fees $ ________________________Expenses:Mileage/travel expense at statutory rate Rate $ __________ x __________ miles = $ _________________________ orAirfare for out-of-state witness (receipts attached) $ _________________________Food and/or lodging expenses due to extraordinary circumstances(receipts and itemization attached) $ _________________________Total Expenses $ _________________________Total Payment Requested $ _________________________Dated: ___________________________ ______________________________ Signature of Attorney Reviewed by District Administrator/designee: ______________________________Date: ________________Approved by Judge or Magistrate: ______________________________ Date: ________________