American LegalNet, Inc. www.FormsWorkFlow.com MAIL TO: Office of Indigent Defense Services, P.O. BOX 302602, Montgomery, Alabama 36130-2602. Filed in the Clerk’s Office at ____________________________________________________, Alabama, on __________________________. date .SECIVRES ESNEFED TNEGIDNI FO ECIFFO EHT OT DETTIMBUS NEHT DNA ,KRELC EHT HTIW DELIF ,NOITACIFITREC ROF TRUOC ETALLEPPA EH T FO ECITSUJ FEIHC RO EGDUJ GNIDISERP RO EGDUJ TRUOC LAIRT EHT OT DETTIMBUS EB TSUM NOITAZIMETI DEHCATTA HTI W MROF SIHT .EGDUJ EHT DNA YENROTTA EH T FO SERU TANGIS LANIGIRO NIATNOC TSUM MROF SIHT .sgnideecorp noitcivnoc’tsop ni dna ,)truoC emerpuS amabalA eht ot iraroitrec fo tirw rof noititep gnidulcni( laeppa no ,level lairt eht ta stnadnefed tnegidni tneserper ot detnioppa lesnuoc yb derrucni sesnepxe yranidroartxe dna seef yenrotta fo tnemyap eht rof edivorp ,5791 edoC .alA ,32’21’51 hguorht 12’21’51 snoitceS NOTICE TO ATTORNEY AND JUDGE: etaD ________________________________________ J erutangiS s’egdu _________________________________________________________________ .dedivorp esnefed eht no desab elbanosaer si mialc eht taht noinipo eht fo rehtruf ma I .dedulcnoc neeb sah rettam dias taht dn a rettam siht ni noitatneserper dedivorp mialc siht gnitneserp yenrotta eht taht yfitrec ybereh ,egduj dengisrednu eht ,I ______________________ rebmuN xa F ____________________ rebmuN enohpeleT _____________________________________:sserddA liamiE _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ (please type or print) (including city, state, and zip code) _____________________________________ edoC yenrottA yenrottA fo sserddA gniliaM y ____tA f _ er _ angi _ _________________________________________________enrot___o __ut____S )esiwrehto ro noinapmoc( esac yna ni s4esnepxe dna segrahc fo noitacilpud a ton si mialc evoba eht taht eralced rehtruf I .elbayap dna eud si tnuoma eht dna yenrotta na sa reh/mih yb deredner yllautca secivres eht stneserper dna tcerroc dna eurt si mialc evoba eht taht seralced rehtruf yenrotta dengisrednu ehT This form and attachments must be received by the Office of Indigent Defense Services no later than 90 days from final disposition of the case. Attorneys serving in the capacity as Guardian Ad Litem must be certified as per Ala. Code (1975) §12-15-304. .sdrocer ruoy ro ypoc a dna drocer s’truoc eht rof emas fo ypoc a ekaM .sredro truoc gnidnopserroc dna sesnepxe lla rof tpiecer ro eciovni lanigiro hcattA .ytivitca hcae ni devlovni emit fo tnuoma dna snoitca fo etad eht gnitcelfer sesnepxe daehrevoinon elbasrubmier )5( ro/dna ;sesnepxe trepxe )4( ;slaeppa rof noitaraperp )3( ;noitaraperp truocifoituo )2( ;secnaraeppa truocini )1( fo noitazimeti etelpmoc a fo ypoc a hcattA .mrof siht etelpmoC :YENROTTA OT ECITON ______________________ Y ENROTTA FO MIALC LATOT ___________________ ___________________ ___________________ = ruoh rep 00.07 $ x __________ sruoH latoT ___________________ = ruoh rep 00.07 $ x __________ sruoH latoT ___________________ = ruoh rep 00.07 $ x __________ sruoH latoT )stpiecer hcattA( sesnep xE daehrevoinoN elbasrubmieR )truoc yb ecnavda ni devorppa fI( sesnepxE trepxE )leveL etalleppA( noitaraperP )gnideecorP noitcivnoCitsoP ro leveL lairT( noitaraperP truoCifoitu O )gnideecorP noitcivnoCitsoP ro leveL lairT( ecnaraeppA truoc nI )5( )4( )3( )2( )1( (Adjudication of dependency, in need of supervision or delinquency, cert. denied, etc.) _________________________________________________________________________________________________________________________ ______________________________________________ , ________________ yb fo desopsid saw esac eht ___________________________)etad( no dna renoititep naidotsuc lagel / naidraug lagel / tnerap dlihc eht tneserper ot dengisrednu eht detnioppa ,egduJ ,_______________________ , ___________________________________ elbaronoH eht ____________________________ )etad( no taht seralced yenrotta dengisrednu ehT _________________________________ ________________________________ _________________ O )ebircsed( reht noisivrepuS fo deeN n I ycnednepeD ycneuqnileD amaba lA fo truoC emerpuS slaeppA liviC fo truoC amabalA s laeppA lanimirC fo truoC amabalA Type of Case: __________________ O )ebircsed( reht yenrottA s’tneraP yenrottA s’dlihC metiL dA naidrauG Appeal to: Role: N E ro rebmuN ytiruc laicoS I F ______________________________________eS______ __ ______________________________________________ County __________________________ In the Juvenile Court of: Attorney Name (Please type or print) State of Alabama Unified Judicial System ATTORNEY’S FEE DECLARATION Form C-62E (Juvenile) [For Appointments made on or after 6/14/2011] Rev.6/2011 Jurisdiction County Code __ __ Year Case# Suffix __ ____ _____ __ Case Number