UNITED STATES DISTRICT COURT ­ DISTRICT OF NEBRASKA Contract Court Reporter Statement of Services Name/Firm (Payee):________________________________________________Invoice #:_________________________ Address:__________________________________________________________________________________________ City, State, Zip: ____________________________________________________________________________________ Soc Sec/Tax ID # (Payee):__________________________E-Mail:____________________________________________ Phone:___________________________________________ Fax:____________________________________________ Court Reporting: Case Number Case Caption Judge Date Time: (From) Time: (To) Total Hours ___________ ___________ ___________ ___________ Full Days Half Days Overtime Cancellation Fee @ @ @ @ $_____________ $_____________ $_____________ $_____________ Total $_____________ Travel Expenses (if applicable): _________________________________________________________________________________________________ Total $_____________ I certify that I performed court reporting services, as claimed above, and that the fees charged are in accordance with the District of Nebraska's Contract Court Reporter Statement of Work. ________________________________________________________Total Amount Claimed $____________________ Court Reporter Signature Date __________________________________________________________ Court Reviewer Signature Date Mail Invoice to: Clerk, U.S. District Court 111 S 18th Plaza, Ste 1152 Omaha, NE 68102-1322 Forms and Court Plans located at www.ned.uscourts.gov Last Revision Date: 9/3/2014 American LegalNet, Inc. www.FormsWorkFlow.com