State of Alabama Unified Judicial System ATTORNEY’S FEE DECLARATION Form C-62B (Juvenile) [For Payment Requests On or After 11/02/2009] Rev.11/09 County Code __ __ Case Number __ ____ _____ __ Jurisdiction Year Case# Suffix IN THE JUVENILE COURT Attorney Name (Please type or print) OF ____________________________ COUNTY ________________________________________________________ In the matter of juvenile case number above ________________________________________________________ Social Security Number or FEIN Appeal to: Alabama Court of Criminal Appeals Alabama Court of Civil Appeals Supreme Court of Alabama Type of Case: Role: Delinquency Guardian Ad Litem Dependency Child's Attorney In Need of Supervision Parent's Attorney Other (describe): _____________________________ Other (describe):______________________ The undersigned attorney declares that on (date) _________________________________, the Honorable ___________________________________ ______________________________________________________________________________, Judge, appointed the undersigned to represent the child parent/legal guardian/legal custodian, petitioner and on (date) ________________________, the case was disposed of by ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ (Custody to DHR, Custody to DYS, Probation, Consent Decree, etc.) The undersigned attorney further declares that he/she has provided services in the case as attorney or guardian and litem and makes the following claims for such services: (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. * NOTE: In juvenile cases, this fee shall not exceed $2,000. Attorneys serving in the capacity of Guardian Ad Litem must be certified as per Ala. Code 1975, §12-15-304. 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) and that if serving as a Child's Attorney or Guardian Ad Litem, I have performed the duties required under Ala. Code 1975, §§12-15-202 and/or 12-15-304 as applicable. Sworn to and subscribed before me this ____________ day of _______________________________________ _________________________________________________________________ Signature of Attorney Attorney Code _____________________________________ Mailing Address of Attorney (please type or print) (including city, state, and zip code) _________________________________________________________________ _________________________________________________________________ _____________________________________________ 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 the attorney is not duplicating these 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 ________________, 20__. _________________________________________________________________ Judge’s Signature NOTICE TO ATTORNEY AND JUDGE: Ala. Code, 1975 §§ 15-12-21 through 15-12-23, provide that fees and expenses of court-appointed attorneys shall be paid by the State of Alabama. 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 FOR AUDIT. MAIL TO: State Comptroller, Indigent Defense Section, P.O. BOX 302602, Montgomery, Alabama 36130-2602. Filed in the Clerk’s Office in ______________________________ County, Alabama, on ___________________ . date American LegalNet, Inc. www.FormsWorkFlow.com