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Request By Court Appointed Counsel For Reimbursement Of Expenses - Maryland
| Request By Court Appointed Counsel For Reimbursement Of Expenses Form. This is a Maryland form and can be used in Criminal Justice Act Panel District Court Federal . |
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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND Plaintiff(s) vs. Defendant(s) Request by Court Appointed Counsel for Reimbursement of Expenses Name of person represented: Date of appointment: Date of judgment or date appointment ended: Have you previously applied for reimbursement in this case? No Yes amount received: If you answered yes, attach copies of all prior applications. Civil Action Number: I hereby request reimbursement for the following costs (do NOT include any expenses previously reimbursed): Deposition expenses (attach invoices or a statement with the deponent's name, date of deposition, number of pages, and per page rate) ................................................................................................................................ $ Expert, investigative, or other services (attach receipts; and if approved in advance, a copy of the order approving; if not approved in advance explain why) .......................................................................................... $ Travel expenses, including tolls, parking, and mileage ..................................................................................... $ Witness fees/Service fees (attach invoices, receipts or copies of checks)........................................................... $ Interpreter services (attach invoices or receipts) ................................................................................................. $ Copies, photographs, long distance calls, etc. (actual out-of-pocket expenses only, not normal office overhead) ............................................................................................................................................................ $ Other expenses (attach receipts and a statement describing expenses) ............................................................... $ TOTAL ........................................... $ DECLARATION I declare under penalty of perjury that the foregoing costs are correct and were necessarily incurred in this action and that I have not been compensated or reimbursed for these costs from or on behalf of the client. None of the costs listed represent fees or costs taxed against myself or the client. Signature of Attorney and Date Printed Name of Attorney Address Expenses in the amount of are approved. Date United States District/Magistrate Judge Request by Court Appointed Counsel for Reimbursement of Expenses (Rev. 6/09) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for completing Request by Court Appointed Counsel for Reimbursement of Expenses NOTE: Regulations Governing the Reimbursement of Expenses in Pro Bono Cases are contained in Appendix C to the Local Rules of the United States District Court for the District of Maryland. $ $ $ $ $ $ $ $ $ $ $ $ $ This form is only for use in cases where counsel has been court appointed. There is a total expense limit of $5,000.00. Upon request forwarded by the presiding judge, the Attorney Admissions Committee may increase this limit. There is a limit of $500.00 for individual expenses unless advance approval was obtained from the presiding judge. A request must be filed no later than thirty days from the entry of judgment or the date counsel's appearance is terminated, whichever is earlier. A request may be made while a case is pending for interim expenses. Do not seek reimbursement for expenses awarded as costs or attorneys' fees. Do not seek reimbursement for costs or expenses awarded against you or your client. Be sure to fill in your client's name, the date of your appointment, and, if applicable, the date of judgment or date your representation ceased. Whenever available attach receipts or invoices for expenses. If other documentation is not available, attach a statement detailing the expense. If the reason an expense was incurred is not readily apparent, attach a statement explaining why it was necessary. Mileage is reimbursable at the rate allowed for government travel at the time the expense was incurred. The current mileage rate is in the Schedule of Fees posted on the Court's web site: www.mdd.uscourts.gov or on the GSA web site: www.gsa.gov. When you request reimbursement for mileage include the number of miles traveled each way and the rate at which you calculated the amount of reimbursement. Do NOT include any expenses which were previously reimbursed. If interim expenses were approved, fill in the amount approved and attach copies of all interim requests for reimbursement. Upon completion of the form, please return to the following address: U.S. Courthouse Attn: Pro Bono Coordinator 6500 Cherrywood Lane, Second Floor Greenbelt, MD 20770 Request by Court Appointed Counsel for Reimbursement of Expenses (Rev. 6/09) American LegalNet, Inc. www.FormsWorkFlow.com
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