Claim Against Pima County

CLAIM AGAINST PIMA COUNTY, ARIZONA _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Invoice_______________NAME:______________________________TIN:____________________________________ Invoice Date__________ADDRESS:___________________________________________________________________ Invoice Amount__________ Mailing Instructions:_________________________________________________________ GUARDIANSHIP OF: No.______________________ PAY ORDER Judge: IT IS ORDERED that the Pima County Finance Director pay to ________________________________ _________________________________________________ the sum of $____________________________________ GUARDIANSHIP Court Appointed Investigator ($20/hr) __________________________________________________________ Court Appointed Attorney ($50/hr) __________________________________________________________ Other __________________________________________________________________________________________ Number of miles _________________________________ Copies __________________________________________ Postage _________________________________________ Total Invoice _______________________________ SERVICE PROVIDER DATE SUPERIOR COURT JUDGE DATE FOR FINANCE DEPARTMENT USE ONLY Audited By__________ Pay Entity_____________ Approved By________ Vendor #______________ Due Date___________ Model #______________ COUNTY DEPARTMENT CERTIFICATION I have examined this demand; expenditure is for a valid public purpose and funds have been appropriated or are otherwise available for payment of this demand; and if the funds are from a Federal grant, contract or source, this demand is allowable under the terms of such grant, contract or source; and payment of the amount claimed is hereby approved. APPROVED BY DEPARTMENT DIRECTOR/DESIGNATED AUTHORITY INSTRUCTIONS: Complete one pay order for each case for fees and costs as shown. This form must be submitted in triplicate. Original goes to Court file; copies to Court Administration. ____________________________________________________________________ Signature Date American LegalNet, Inc. www.FormsWorkflow.com CLAIM AGAINST PIMA COUNTY, ARIZONA _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Invoice_______________NAME:______________________________TIN:____________________________________ Invoice Date__________ADDRESS:___________________________________________________________________ Invoice Amount__________ Mailing Instructions:_________________________________________________________ GUARDIANSHIP OF: No.______________________ PAY ORDER Judge: IT IS ORDERED that the Pima County Finance Director pay to ________________________________ _________________________________________________ the sum of $____________________________________ GUARDIANSHIP Court Appointed Investigator ($20/hr) __________________________________________________________ Court Appointed Attorney ($50/hr) __________________________________________________________ Other __________________________________________________________________________________________ Number of miles _________________________________ Copies __________________________________________ Postage _________________________________________ Total Invoice _______________________________ SERVICE PROVIDER DATE SUPERIOR COURT JUDGE DATE FOR FINANCE DEPARTMENT USE ONLY Audited By__________ Pay Entity_____________ Approved By________ Vendor #______________ Due Date___________ Model #______________ COUNTY DEPARTMENT CERTIFICATION I have examined this demand; expenditure is for a valid public purpose and funds have been appropriated or are otherwise available for payment of this demand; and if the funds are from a Federal grant, contract or source, this demand is allowable under the terms of such grant, contract or source; and payment of the amount claimed is hereby approved. APPROVED BY DEPARTMENT DIRECTOR/DESIGNATED AUTHORITY INSTRUCTIONS: Complete one pay order for each case for fees and costs as shown. This form must be submitted in triplicate. Original goes to Court file; copies to Court Administration. ____________________________________________________________________ Signature Date American LegalNet, Inc. www.FormsWorkflow.com CLAIM AGAINST PIMA COUNTY, ARIZONA _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Invoice_______________NAME:______________________________TIN:____________________________________ Invoice Date__________ADDRESS:___________________________________________________________________ Invoice Amount__________ Mailing Instructions:_________________________________________________________ GUARDIANSHIP OF: No.______________________ PAY ORDER Judge: IT IS ORDERED that the Pima County Finance Director pay to ________________________________ _________________________________________________ the sum of $____________________________________ GUARDIANSHIP Court Appointed Investigator ($20/hr) __________________________________________________________ Court Appointed Attorney ($50/hr) __________________________________________________________ Other __________________________________________________________________________________________ Number of miles _________________________________ Copies __________________________________________ Postage _________________________________________ Total Invoice _______________________________ SERVICE PROVIDER DATE SUPERIOR COURT JUDGE FOR FINANCE DEPARTMENT USE ONLY Audited By__________ Pay Entity_____________ Approved By________ Vendor #______________ Due Date___________ Model #______________ DATE COUNTY DEPARTMENT CERTIFICATION I have examined this demand; expenditure is for a valid public purpose and funds have been appropriated or are otherwise available for payment of this demand; and if the funds are from a Federal grant, contract or source, this demand is allowable under the terms of such grant,