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Application And Order For Payment Of Court Appointed Vendor Form. This is a California form and can be use in Fresno Local County.
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Tags: Application And Order For Payment Of Court Appointed Vendor, PGN-90, California Local County, Fresno
NAME AND ADDRESS OF VENDOR:
PHONE:
For Court Use Only:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO
1100 Van Ness Avenue
Fresno, CA 93724-0002
CASE NAME:
APPLICATION AND ORDER FOR PAYMENT OF COURT APPOINTED VENDOR
(Not to be used for court appointed special circumstance attorney claims)
CASE NUMBER:
NOTE TO ALL VENDORS: COPY OF COURT ORDER APPOINTING VENDOR MUST ACCOMPANY THIS FORM.
STANDARD RATE PSYCHOLOGICAL/
PSYCHIATRIC EVALUATION CLAIM:
COURT APPOINTED SERVICES (EXPERT, INVESTIGATOR, ETC.) CLAIM:
(Provide Attachment A for itemization of services and mileage, and
Attachment B with original receipts for expenses.)
a. Date appointed:
by Judge
a.
hours at $
per hour
$ 0.00
b. Evaluation date:
b. Mileage (
miles at $
per mile)
$ 0.00
0.00
c. Type of evaluation:
c. Expenses
$ 0.00
TOTAL
$ 0.00
d. Fee:
NOTE: If you have written preapproval for more than
Signature of attorney of record required on Attachment A for expert or
the standard rate, fill out the expert services portion of
investigator billing prior to submission.
this form.
COURT APPOINTED ATTORNEY DECLARATION AND CLAIM:
I am an attorney at law duly admitted to practice in the State of California. I have not received compensation for this claim except as noted
below. I hereby make application for payment of fees as follows:
(See footnote * below before completing.)
A. Appointed on (date)
to represent (name)
(Client’s relationship to case:
)
B. This is the only billing for this case and legal services have been terminated
and required less than 3 hours - flat fee $240 $
Expenses: $
C. Interim billing for services from
to
(If interim billing, date of prior billing:
)
D. Legal services terminated on or about (date):
E. Attorney’s fees: $
Expenses: $
(other than $240 flat fee)
Total amount claimed for A through E (Provide Attachment A for itemization of
TOTAL $ 0.00
services and Attachment B with original receipts for expenses):
I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed on (Date):
at (Place)
, California.
(Type or print name)
FOR COURT USE ONLY:
,
(Signature of applicant)
ORDER
The foregoing application has been considered and the court finds the following fees to be reasonable:
a. Fees:
$
b. Expenses
$
c. Mileage
$
TOTAL:
$
It is ordered that the total shown above in item 2c be paid by
Fresno County
Superior Court.
Dated:
Judge of the Superior Court
*Declarations under penalty of perjury signed in California may be used in place of affidavits (CCP 2015.5).
Affidavits required when signed outside California.
APPLICATION AND ORDER FOR PAYMENT OF COURT APPOINTED VENDOR FEES AND EXPENSES
PGN-90 E05-11
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