12/98 W.Va. Crime Victims Compensation Fund 1900 Kanawha Blvd., E. Rm. W-334 Charleston, WV 25305-0610 Page 1 Attorney Fee Voucher Attorney _________________________________ Claimant ____________________ ________ Claim No. CV-_________ The following services were rendered to this claimant in connection with the claim cited above. Legal Services Hours IN Hours OUT Date Court of Court Brief explanation of activity (time and research) Total time IN court ________________ hours x $65.00 = $__ ______________ Total time OUT of court _______________ hours x $45.00 = +________________ Total Services $________________ (enter this amount on page 2)<<<<<<<<<********>>>>>>>>>>>>> 2 Reimbursable Expenses Page 2The following services were rendered to this claimant in connection with Claim No. CV-___________ Type of Expense (telephone, travel, postage, Date expert witness, and court reporter) Notes or Comments Cost Total Expenses $ Summary Total Legal Services (from page 1) $ (056) Total Reimbursable Expenses (from page 2) + (057) Total Claim $ I hereby certify that the statements contained here are true and correct. Complete here for Corporation or Partnership Complete here for Individual Payees Signature Payees Signature Payees Name (please print or type) Payees Name (please print or type) OR Mailing Address Mailing Address City State ZipCity State Zip Corp. Partnership FEIN: SSN: Note: State warrant for attorney fees will be issued in name(s) as completed above. An attorney shall not contract for or receive any larger sum than the amount allowed under this section. W.Va. Code 14-2A-19 .