IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. Plaintiff(s) Defendant(s) Plaintiff(s) Atty. Defendant(s) Atty. Judge A copy of this order Plaintiff Atty. Court Reporter should be sent has been sent Defense Atty. Deputy Clerk Other File Stamp Petition for fees and expenses for Court Appointed Language/Sign Interpreters Now comes your petitioner, Court interpreting firm and states to the Court under oath as follows. 1. Interpreter/firm was appointed , an individual interpreter or employee of to for Judge . 2. The undersigned, individually or on behalf of a Court interpreting firm, certifies that the individual and all Court interpreters employed by the firm who performed service with services with respect to the above file have executed the Interpreters Standards of Conduct pursuant to Local Rule 30.05. 3. Interpreter/firm performed the Court appointed interpreter service from to . The rate charged by the above interpreter Date Time Spent Interpreting per hour. Place 4. Mileage, if any, charged on the above cause is as follows: Mileage is miles from Mileage Charge (b) Tolls (receipts attached) (c) Total charges (a + b + c) Charge (a) Total (a) to Signature of Interpreter/Petitioner Affidavit of Expenses , petitioner in the above-entitled action, being first duly sworn, states that the proceeding is a true and correct statement of interpreter services rendered. State of , County of Signature of Interpreter/Petitioner Signed before me on Notary Public Order for Fees and Expenses for Court Appointed Language/Sign Interpreters Date Approved: Trial Judge: Date Approved: Chief Judge: P1-MR-001 (04/09) [identify copy] American LegalNet, Inc. www.FormsWorkflow.com