THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE CITY AND COUNTY OF SAN FRANCISCO IN THE MATTER OF ___________________ ) ) ) ) ) JD Number: _______________________ DECLARATION OF COURT INTERPRETER I, _______________________, declare as follows: I provided interpreter services in the above captioned case at the request of court appointed counsel __________________________ and pursuant to the attached court order. (name of attorney) Location ___________________ ___________________ Date ____________ ____________ Time (incl. am/pm) _________________ _________________ # of Hours _________ _________ Hourly / ½ Day Rate $ ________ (hourly/1/2 day) $ ________ (hourly/1/2 day) TOTAL DUE: $ ________ I declare under penalty of perjury that the foregoing is true and correct. Executed in San Francisco, California on __________________ (MM/DD/YYYY) _____________________________ SIGNATURE OF INTERPRETER _____________Certification number ___ Non-certified Tax ID: Address: City, State, Zip: Telephone: _________________________ _________________________ _________________________ _________________________ APPROVED: ____________________________________________________________________ (Signature and printed name of court-appointed counsel) American LegalNet, Inc. www.FormsWorkFlow.com