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Statement For Payment Of Interpreters 1-8 - Nebraska
| Statement For Payment Of Interpreters Form. This is a Nebraska form and can be used in Miscellaneous General Statewide . |
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STATE OF NEBRASKA FORM NO. 1:8 STATEMENT FOR PAYMENT OF INTERPRETERS 9/03 Revised Neb. Rev. Stat. 25-2406 Interpreters Name: ______________________________________________________ (Print or Type) Street Address: _________________________________________________________ City, State, Zip: _________________________________________________________ Social Security Number: , or Federal Taxpayer Identification Number: Language(s) Day Telephone: ( )__________________ I hereby certify that I served as interpreter as detailed below: Date Hours and Minutes @ Rate Miles* Authorizing Signature County (District, Juvenile or County) Court (15 min. increments) per hour or Probation District and County Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Hr. Min. $ _________________________________ Activity: ________________________________________________________ Attach additional Interpreter Statements if necessary. * Round trip mileage paid @ 36 per mile if interpreter resides more than 15 miles from where interpreting takes place. Totals: Hours Minutes** at rate of $ per hour equals $ , Plus: Miles at rate of 36 per mile equals $ , Equals $ Total Amount Claimed. Date: , Mail to: State Court Administrator Attn: Interpreter Interpreters Signature P.O. Box 98910 Lincoln, NE 68509-8910 th st th Please submit on the 15 and last day of the month. After January 1, 2004, submit between the 1 and the 7 day of the month only. Consolidate statements to as few as possible. Complete the totals accurately. Each entry must have an authorizing signature of a judge, clerk of court, or probation officer. Keep a copy for your records. ** $30.00 hour = $7.50 (15 min.), $15.00 (30 min.), and $22.50 (45 min.).
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