State of Alabama Unified Judicial System Form C-62A Rev.11/07 ATTORNEY’S FEE DECLARATION (Adult) [For Work Performed On or After 10/1/2000] Mark Appropriate Court: Indicate if Original Charge is: Circuit Court of ________________ County Capital Case (or charge carrying sentence of District Court of________________ County life without parole) Class A Felony Municipal Court of_______________ Class B Felony Alabama Court of Criminal Appeals Class C Felony Alabama Court of Civil Appeals Other Supreme Court of Alabama Limits (NO Limit) CC Appeal Petition for Writ of Certiorari Post-Conviction/Habeas Corpus ($3,500) FA ($2,500) FB ($1,500) FC ($1,000) OT ($2,000) AP ($2,000) WC ($1,000) PC Case Number County Code __ __ __ ____ _____ __ Jurisdiction Year Case# Suffix Attorney Name (Please type or print) ____________________________________________ ____________________________________________ Social Security Number or FEIN STYLE OF CASE: STATE OF ALABAMA MUNICIPALITY OF _______________________________ v. ___________________________________________ Defendant CHARGE: _________________________________________________________________________________________________________ Companion case numbers and charges or convictions: ______________________________________________________________________ __________________________________________________________________________________________________________________ The undersigned attorney declares that on (date) __________________________________, the Honorable ___________________________________ _______________________, Judge, appointed the undersigned to represent the above-named defendant or appellant, and on (date) ___________________ the case was heard by the Honorable _____________________________________________________________, Judge. The case was disposed of by _________________________________________________________________________________________________ (Plea of guilty, conviction, acquittal, affirmance, reversal, cert. denied) (1) In court Appearance (Trial Level or Post-Conviction Proceeding) Total Hours __________ x $ 60.00 per hour = ___________________ (2) Out-of-Court Preparation (Trial Level or Post-Conviction Proceeding) Total Hours __________ x $ 40.00 per hour = ___________________ (3) Preparation (Appellate Level) Total Hours __________ x $ 60.00 per hour = ___________________ (4) Extraordinary Expenses (If approved in advance by court) _________________________________________________________ (5) Overhead Expenses (If approved in advance by court) Total Hours __________ x $ ____ Per hour = ___________________ TOTAL CLAIM OF ATTORNEY _______________________________ NOTICE TO ATTORNEY: Complete this form. Attach a copy of a complete itemization of (1) in-court appearance; (2) out-of-court preparation; (3) preparation for appeals;(4) extraordinary expenses; and/or (5)overhead expenses reflecting the date of actions and amount of time involved in each activity. Make a copy of same for the court’s record and a copy for your records. The undersigned attorney further declares that the above claim is true and correct and represents the services actually rendered by him/her as an attorney and the amount is due and payable. I further declare that the above claim is not a duplication of charges and expenses in any case (companion or otherwise) _________________________________________________________________ Signature of Attorney Attorney Code _____________________________________ Sworn to and subscribed before me this ____________ Mailing Address of Attorney (please type or print) (including city, state, and zip code) Day of ___________________________, ___________ _________________________________________________________________ _________________________________________________________________ _____________________________________________ _________________________________________________________________ Notary Public Telephone Number _________________ Fax Number _________________ I, the undersigned judge, hereby certify that the foregoing claim has been presented to me, and I have reviewed the same and believe the same to be true and correct. I am further of the opinion that said attorney is not duplicating said charges and expenses in any case (companion or otherwise). Based on the above, I hereby approve the declaration and claim in the amount of $ __________________________________________________ Done this _______________ day of _______________________________, ___________. _________________________________________________________________ Judge’s Signature NOTICE TO ATTORNEY AND JUDGE: Sections 15-12-21 through 15-12-23, Ala. Code 1975, provide for the payment of attorney fees and extraordinary expenses incurred by counsel appointed to represent indigent defendants at the trial level on appeal (including petition for writ of certiorari to the Alabama Supreme Court) and in post-conviction proceedings. THIS FORM MUST CONTAIN ORIGINAL SIGNATURES OF THE ATTORNEY AND THE JUDGE. THIS FORM WITH ATTACHED ITEMIZATION MUST BE SUBMITTED TO THE TRIAL COURT JUDGE OR PRESIDING JUDGE OR CHIEF JUSTICE OF THE APPELLATE COURT FOR APPROVAL. AFTER APPROVAL, FILE WITH THE CLERK, WHO SHALL SUBMIT THE ORIGINAL DECLARATION TO THE STATE COMPTROLLER (EXCEPT IN MUNICIPAL CASES) FOR AUDIT. Filed in the Clerk’s Office at _______________________________, Alabama, on __________________________. date EXCEPT IN MUNICIPAL CASES, MAIL TO: State Comptroller, Indigent Defense Section, P.O. BOX 302602, Montgomery, Alabama 36130-2602. Original: Comptroller Yellow: Court File Pink: Attorney American LegalNet, Inc. www.FormsWorkFlow.com