MOTION, ENTRY, AND CERTIFICATION FOR APPOINTED COUNSEL FEESIn theCourt of, OhioPlaintiff:Case No. Appellate Case No. (if app.)V.JudgeGuardian Ad Litem (check if appointed as GAL) Capital Offense Case (check if Capital Offense case)In re: Defendant / Party RepresentedMOTION FOR APPROVAL OF PAYMENT OF APPOINTED COUNSEL FEES AND EXPENSESThe undersigned having been appointed counsel for the party represented moves this Court for an order approving payment fees and expenses as indicated in the itemized statement herein. I certify that I have received no compensation in connection with providing representation in this case other than that described in this motion or which has been approved by the Court in a previous motion, nor have any fees and expenses in this motion been duplicated on any other motion. I, or an attorney under my supervision, have performed all legal services itemized in this motion. As attorney/guardian as litem of record, I was appointed onPeriodic Billing (check if this is a periodic bill)COURT COUNTY OF, 20. This case terminated and/or was disposed of on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No., 20. I am submitting this application on., 20Calendar No.NameSignatureJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)AddressSSN/Tax ID No. and StreetCityStateZipSUMMARY OF CHARGES, HOURS, EXPENSES, AND BILLINGOFFENSE/CHARGE/MATTER*ORC/CITY CODEDISPOSITIONDEGREE1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3)2)THE PEOPLE OF THE STATE OF NEW YORK TO*List only the three most serious charges beginning with the one of greatest severity and continuing in descending order.GRANDTOTALHOURSGREETINGS:123456HRS: OUTHRS: IN121110987WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableEnter the grand totals from the Itemized Fee Statement on the reverse side of this form.,Hrs:InX Rate= $$Tot.Feeslocated at County ofMin. FeeHrs:OutX Rate= $Total $ Flat Fee$Expenses, at or adjourned date, to testify and give evidence as a witness in this action on the part of the, 20, on thenoon, and at any recessed in roomo'clock in the day ofJUDGEMENT ENTRYThe Court finds that counsel performed the legal services set forth on the itemized statement on the reverse hereof, and that the fees and expenses set forth on this statement are reasonable, and are in accordance with the resolution of the Board of County Commissioners ofYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.County, Ohio relating to payment of appointed counsel, that all rules and standards of the Ohio Public Defender Commission and State Public Defender have been met., one of the Justices of the, 20 County,day ofCourt in Witness, HonorableIT IS THEREFORE ORDERED that counsel fees and expenses be, and are hereby approved, in the amount of $ It is further ordered that the said amount be, and hereby is, certified by the Court to the County Auditor for payment.Extraordinary fees granted (copy of journal entry attached)Judge(Attorney must sign above and type name below)DateSignatureCERTIFICATIONAttorney(s) forThe County Auditor, in executing this certification, attests to the accuracy of the figures contained herein. A subsequent audit by the Ohio Public Defender Commission and/or Auditor of the State which reveals unallowable or excessive costs may result in future adjustments against reimbursement or repayment of audit exceptions to the Ohio Public Defender Commission.Office and P.O. AddressCounty NumberWarrant DateWarrant NumberTelephone No.: Facsimile No.: E-Mail Address:County AuditorOPD 1026R (4/96)Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OFCASE NUMBERATTORNEY/GAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::IF A CAPITAL OFFENSE CASE, LIST CO-COUNSEL'S NAME HERE: I hereby certify that the following time was expended in representation of the defendant/party represented:Index No.Calendar No.ITEMIZED FEE STATEMENT OUT-OF-COURT HOURSIN-COURT HOURSJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)&INVESTIGATIONCONFERENCESCOURTDISPOSITIONALINTERVIEWING&HEARINGTRIALRESEARCHTRIALCOURTWRITINGNEGOTIATIONOF-TRAVELOUT-OTHERPRE-HEARINGTRIALPLEAHEARINGPOST-HEARINGIN-OTHERTOTALTOTAL DATE OF SERVICE212 11 10 9 8 7 6 5 4 31. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,TOTAL HOURS(Attorney must sign above and type name below)234512111098761HRS: INTime is to be reported in tenth of an hour (6-minute) increments. HRS: OUTI hereby certify that the following expenses were incurred:* Use the following categories for type:Attorney(s) for(1) Experts(6) Other(5) Travel(4) Transcripts(3) records/Reports(2) Postage/PhoneTYPEAMOUNTPAID TOEXPENSEOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:TOTALMobile Tel. No.:* To obtain reimbursement, the purpose of each expens must be clearly identified, and a receipt must be provided for each expenditure over $1.00.American LegalNet, Inc. www.USCourtForms.com
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