x-nonePHONE: x-noneCheck here if new address x-noneMileage Ratex-none$0.580 x-noneHalf Day(mark box) x-noneFull Day(mark box) x-none*Interpreter address if different from above: x-noneX x-noneXx-noneXx-noneDatex-nonein San Bernardino Countyx-noneXx-noneDatex-noneDatex-noneVENDOR CODE: x-none-$ x-none-$ x-noneLINE 4: x-noneForm No. SB-17710 Rev. 1/1/2019 x-noneOriginal: Court Photocopy: Claimant x-noneLINE 1: x-noneLINE 3: x-noneLINE 2: x-nonePosted by (initials) x-noneDOCUMENT TOTAL:$ x-noneFUND x-noneORDER CODE x-noneG/L ACCT x-noneDOCUMENT ID: x-noneApproved by (signature) x-noneX x-noneVerifying Coordinator Signature x-nonein San Bernardino County x-none COORDINATOR STATEMENT: The services reported were necessary, directed by the appropriate authority, verified in accordance with established procedures and rendered as set forth above."I certify (or declare) under penalty of perjury that the foregoing is true and correct": x-noneDate x-noneCOURT USE ONLY BELOW THIS LINE x-none APPROVAL FOR PAYMENT: I have examined the facts of the transaction set forth herein and the documents attached hereto. All verifications, certification, and checking of computations required by the Trial Court Financial Policies and Procedures manual have been complied with and this claim is in the total amount shown and it is hereby approved for payment."I certify (or declare) under penalty of perjury that the foregoing is true and correct": x-nonein San Bernardino County x-noneCost/Fund Center x-noneAMOUNTS x-noneCITY/STATE: x-noneFID/SS NO.: x-noneCASE TYPE (see table below) x-noneCASE NAME x-noneMiles x-noneSuperior Court of California, County of San Bernardino x-noneINTERPRETER SERVICES CLAIM x-noneZIP: CERTIFICATION/REGISTRATION # x-noneREQUIRED x-noneADDRESS*: x-noneCOURT SITE CODE (see table above) x-noneCASE NUMBER x-noneDATE OF SERVICE x-nonePER DIEM x-noneTotal Fee CHECK ONE x-none JUDICIAL COUNCIL CERTIFIED/REGISTERED x-none NON-JUDICIAL COUNCIL CERTIFIED/REGISTERED LANGUAGE x-noneINTERPRETER NAME: x-noneCLAIM PAYABLE TO: x-noneMILEAGE (paid for actual miles driven above 60 miles) x-noneMileage total @ $0.58/mile x-noneTotal Per Diem & Mileage x-none-$ x-none-$ x-none-$ x-noneClaimant Signature x-noneTOTAL CLAIM x-none CLAIMANT STATEMENT: The foregoing claim for services is true and correct. I understand that while serving as an interpreter in San Bernardino County Superior Courts, I am obligated to interpret in any court and/or District as needed without payment in addition to the summoning Court's applicable fee schedule. I hereby certify that no request for additional payment has been or will be made."I certify (or declare) under penalty of perjury that the foregoing is true and correct": x-nonePlace (city or county) x-none-$ x-none-$ x-none-$ x-none-$ x-noneFunc. areaPECT x-none1320 x-none1320 x-none1320 x-none1320 x-noneWBS Element American LegalNet, Inc. www.FormsWorkFlow.com