STATE OF NORTH CAROLINA In The General Court Of Justice District Superior Court Division County File No. Additional File No(s). Check Here If This Fee Application Covers Multiple Charges Name And Address Of Indigent Client Provide all case numbers resolved on the same day in the same court before the same judge. Date Attorney Appointed Full Social Security No. (required by G.S. 7A-455(d)) NON-CAPITAL CRIMINAL CASE TRIAL LEVEL FEE APPLICATION ORDER FOR PAYMENT JUDGMENT AGAINST INDIGENT Has No Social Security No. the trial level, potentially capital cases at the trial level, appeals to the Court of Appeals or Supreme Court, or capital post-conviction cases. Attorneys should consult IDS Rule 1.9(a)(1a) for deadlines on the submission of final fee applications, as well as IDS' billing policies, available at www.ncids.org. INSTRUCTIONS: Applicant completes and signs all applicable portions of Section I. The trial judge completes Sections II and III and signs Section IV to award payment or fix value of services and enter the appropriate judgments. If no judgments are to be entered, the trial judge must so indicate in Section III. Clerk mails private appointed counsel fee applications to: IDS Financial Services Office, Courier Box 56-10-50, Raleigh, NC, OR if courier is not available, mail to P.O. Box 2448, Raleigh, NC 27602. G.S. Ch. 7A, Art. 36; G.S. 122C-268(d), -286(d) NOTE: Use this form ONLY for non-capital criminal cases at the trial level - i.e., only for cases with a CR or CRS case caption. DO NOT use this form for non-criminal cases at - I. APPLICATION I, the undersigned assigned counsel, public defender, IDS contract counsel, make application for payment and reimbursement of necessary expenses incurred, or for determination of value of services rendered for the indigent. I certify that this information is correct to the best of my knowledge. MOST SERIOUS ORIGINAL CHARGE AND MOST SERIOUS DISPOSITION: Check ONE box in each of the three following columns. 1. Original Charge (most serious offense) 2. Disposition (most serious disposition) 3. Judgment & Sentencing (most serious) Felony Offense Guilty Plea Before Trial: Most Serious Original Charge Active Sentence Must Indicate Felony Class: Length of Sentence: Guilty Plea Before Trial: Other Offense Name of Offense: Name Of Offense: Split Sentence Guilty Plea During Trial: Other Offense Supervised Probation Felony Probation Violation Name Of Offense: Unsupervised Probation Misdemeanor Offense (Non-Traffic) Trial: Guilty Most Serious Original Charge Probation Terminated Must Indicate Misd. Class: Trial: Guilty Other Offense PJC (if Class 3, attach Order Of Assignment) Name Of Offense: Fines And Costs Only Misdemeanor Probation Violation Trial: Acquitted None (Acquitted/Dismissed) DWI Probation Violation Found None (Deferred/Diverted) Other Traffic Dismissed With Leave Dismissed Without Leave None (Attorney Withdrew) Must Indicate Misd. Class: FTA/OFA Without Dismissal (if Class 3, attach Order Of Assignment) None (Interim Fee) Deferred/Diverted Criminal Contempt Other*: Held In Criminal Contempt *(Check only if none of the above) Treatment Court (in columns 2 and 3, No Probable Cause check Other) Attorney Withdrew (reason): Satellite-Based Monitoring Hearing (in columns 2 and 3, check Other) None (Interim Fee) Non-Capital Motion For Appropriate Other*: Relief (in columns 2 and 3, check Other) *(Check only if none of the above) Other*: *(Check only if none of the above) Disposition Date FINAL FEES ONLY: NOTE: In assigned counsel cases, the applicant is always the individual attorney. If payment is to be made to individual applicant, write "same" under Payee and give applicant's taxpayer ID No. (Federal Employer ID No. or, if no Federal Employer ID, SSN). If payment is to be made to applicant's firm, give firm name as Payee and firm's taxpayer ID No. Name Of Applicant Address Payee (see Note) Taxpayer ID No. (see Note) Email Address Telephone No. Date Signature Of Applicant Check here if you were appointed to represent this defendant in another case(s) at the time of the appointment to this case(s) and you already submitted a fee application for that case(s) in which the attorney appointment fee was charged. Date First Substantive Client Interview Prior Total Fees And Expenses Allowed Ending Date This Fee Request COMPLETE FOR Beginning Date This Fee Request THIS FEE: (Attach $ detailed time sheets Name Of Judge Setting Fee Time In Court Time In Court Waiting Total Time Claimed This Fee Time Out Of Court when required by judge. Time must be reported in decimals, Travel (no. of miles) Copying (if in-house, no. of copies) Other (attach receipts if > $ 25) Total Expenses not minutes.) $ $ $ $ II. ORDER TO PAY OR FIX VALUE OF SERVICES Based on the Findings of Fact set out in Section III, the Court ORDERS that the "Total Amount" stated on Line 4 below be: (Assigned Counsel) paid by the State of North Carolina to the payee named above. (Public Defender/IDS Contractor) fixed as the value of legal services and other expenses of representation rendered by the applicant named above. 1. Hours Approved By The Court 2. Fees Allowed/Value Of Services Rendered 3. Other Necessary Expenses Allowed By The Court (Hours Approved x IDS Rate) = 4. TOTAL AMOUNT AOC-CR-225, Rev. 9/15 © 2015 Administrative Office of the Courts (Over) $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com III. FINDINGS OF FACT AND JUDGMENTS After due notice to the defendant named on the reverse and opportunity to be heard, the Court finds that the defendant has previously been adjudged to be indigent; that he/she requested and has been provided counsel and other necessary expenses of representation; and that the applicant named on the reverse provided services and incurred expenses of which the money value is that stated in Line 4 of Section II, plus any interim fees listed in the box in Section I labeled "Prior Total Fees And Expenses Allowed." NOTE: Sign Section IV to enter judgments against the indigent defendant for the full value of attorney fees and expenses plus the attorney appointment fee. If no judgments are to be entered, or judgments are to be entered for a different amount, the trial court must fill in the appropriate blanks below. When entering Judgment #1, the trial court should verify the amount of any interim fees awarded. NOTE: To enter Judgment #1 against a parent/responsible person pursuant to G.S. 7A-450.1 et seq., a separate order must be entered (may be