COLORADO JUDICIAL DEPARTMENT REQUEST AND AUTHORIZATION FOR PAYMENT OF FEES FOR COUNSEL, GAL (ADULT REPRESENTATION ONLY), NON-ATTORNEY CHILD & FAMILY INVESTIGATOR, COURT VISITOR, INVESTIGATOR (Complete Sections I- VI, sign, date and submit to Court – See reverse side for Instructions) I. Case Number: for Repr. of: Court: District Case Name: Number of Persons Represented: County: Current Judge/Magistrate: Appointing Judge/Magistrate: II. Appointee Information: Complete or check all that apply: Name: Phone: Address: Fax: City: Email: County Atty. Reg. No. State: Check if new address Zip: The information in this box is confidential and NOT to be viewable in court case file SSN/Tax ID: First Time Appointees: See instruction #4 on reverse (Per I.R.S. Reg. # 301.6109-1, the Social Security number of payee is mandatory for reporting on I.R.S. Form 1099.) Appointment Date: Originally contract appointment. Original appointee or Substitute appointee Case Reason for hourly bill: on (date). III. APPOINTMENT TYPE (check one): Counsel Attorney GAL (Adult Representation Only) Non-Attorney GAL/Child Family Inv. (CFI) Investigator Court Visitor has has not gone to trial. IV. APPOINTMENT AUTHORITY (check one): Title 14 DOMESTIC REL. CHILD(REN) % State pays for Title 15 PROBATE Title 19 D & N CHILD(REN) Title 19 D & N RESPONDENT PARENT Title 19 D & N SPECIAL RESPONDENT Title 19 JUVENILE DELINQUENCY Title 19 PATERNITY/SUPPORT State pays for % Title 22 EDUCATION CODE (Truancy) Title 25 DRUG/ALC. COMMIT. Title 27 MENTAL HEALTH ADVISORY COUNSEL WITNESS (CJD 04-04) CRCP 107 CONTEMPT 13-90-208 WAIVER OF HEARING INTERP. OTHER V. INDIGENCE Responsible party(ies) determined to be indigent on (mm/dd/yy). Not indigent, but responsible party(ies) refuse payment without good cause (appt. for JD counsel). Reimbursement to be ordered to the state. Not indigent, but responsible party(ies) refuse payment with good cause, i.e. family member victim (appt. for JD counsel). Indigence cannot be determined. Reason: VI. SUMMARY OF BILLED ACTIVITIES (see instructions on reverse) Column 1 Dates of service before 7/1/07 Activity from (mm/dd/yy) to Column 2 Dates of service 7/1/07 and on Activity from (mm/dd/yy) Column 3 TOTAL AMOUNT to Total Hours Attorney out-of-court hours x $57.00 rate $0.00 out-of-court hours x $60.00 rate $0.00 0 $ 0.00 in-court hours x $57.00 rate $0.00 in-court hours x $60.00 rate $0.00 0 $ 0.00 Appellate hours $57.00 rate $0.00 Appellate hours x $60.00 rate $0.00 0 $ 0.00 hours x $25.00 rate $0.00 0 $ 0.00 hours x $20.00 rate $0.00 0 $ 0.00 hours x $33.00 rate $0.00 0 $ 0.00 hours x $25.00 rate $0.00 0 $ 0.00 Non-Attorney Paralegal GAL/CFI hours x $25.00 rate $0.00 hours x $20.00 rate $0.00 Investigator hours x $33.00 rate $0.00 Court Visitor hours x $33.00 rate $0.00 Expenses: miles x .39 (travel before 1/1/08) copies x 10 cents per copy Misc. (attach itemized receipts if over $50) : $ miles x .46 (travel 1/1/08 forward) postage $ long distance miles x (other rt. $ other ( per §24-9-104 CRS) ) $ 0.00 TOTAL REQUEST Total Amount Previously billed $ $ 0.00 $ 0.00 $ 7.80 Total of Requests Exceed Allowed Maximum for appointment. Motion and Order for Excess Fees was granted and is attached. The information provided in this request is true and accurate. No compensation for the services described has been received. A detailed itemization of the incourt and out-of-court hours is attached. I have reviewed “Court Appointee Procedures for Payment of Fees and Expenses” in Chief Justice Directive 04-04 or 0405 and understand that payment may be adjusted for items that do not comply with the Department’s procedures. All court appointees and investigators must submit their JDF 207 (or invoice using CACS, as applicable) to the Court within six months of the earliest date of billed activity. ____________________________________________________ Final Bill ______________________________ Signature of Appointee Date *****Court Personnel Only**** Request has been reviewed by district staff for accuracy and completeness, and payment is approved (with adjustments as indicated, if any). Net Adjustment (+/-) $___________ Reason for adjustment (if not otherwise noted above) ________________________________________________ Reimbursement was ordered and entered in CAC On-line System when Appointment was entered. Court Staff Verified that appointment was created in CAC On-line System (to enable appointee to be paid) _______________________________________________ Signature of District Administrator, Judge/Magistrate or Designee JDF 207T R1/08 ________________________________________________ Typed or Printed Name SCAO REQUEST AND AUTHORIZATION FOR PAYMENT OF FEES FOR COUNSEL, GUARDIAN AD LITEM (ADULT REPRESENTATION), NON-ATTORNEY CHILD & FAMILY INVESTIGATOR, COURT VISITOR, INVESTIGATOR ___________ Date American LegalNet, Inc. www.FormsWorkflow.com 1. HOURLY RATES Hourly rates are paid in accordance with the applicable Chief Justice Directive (i.e. 04-04, 04-05) or Chief Justice Order. 2. MAXIMUM FEES The maximum total fees authorized per appointment as established in Chief Justice Directive 04-05 are as follows: Title 19 – Dependency and Neglect Matters Respondent Parent Counsel $2,650 CFI (non-attorney) $1,000 Titles 14 and 15 Counsel (probate only) GAL (attorney) GAL or CFI (non-attorneys) Court Visitor $2,500 $2,500 $1,000 $ 500 Title 19 – Other Matters (i.e. delinquency GAL support, adoption, paternity, etc.) GAL or CFI (non-attorneys) $ 500 Titles 22, 25 and 27 Counsel GAL (attorney) for adult $ 675 $ 675 Appeals Counsel/GAL (attorney) for adult CFI (non-attorney) $2,650 $1,000 For maximum total fees for counsel in criminal and juvenile delinquency cases, refer to Attachment D (2) of Chief Justice Directive 04-04. If the total payment request for an appointment exceeds the maximum fee, a Motion for Fees in Excess must be submitted to the court and granted pursuant to Chief Justice Directives 04-04 and 04-05. 3. REIMBURSABLE EXPENSES Allowable expenses are detailed in Attachments D (Guidelines for Payment) and E (Procedures for Payment) of Chief Justice Directive 04-05 and in Attachments E (Guidelines for Payment) and F (Procedures for Payment) and of Chief Justice Directive 0404. All items must be detailed, itemized, and legible. If a charge exceeds $50.00, a receipt must be attached. Chief Justice Directives are available at www.courts.state.co.us or contact the Financial Services Division of the State Court Administrator’s Office for copies. 4. I.R.S. W-9 FORM AND “AUTHORIZATION TO PAY A LAW FIRM FOR ATTORNEY APPOINTMENTS” FORM A completed W-9 form containing the appointee’s Tax Identification Number (Social Security Number or Federal Employer Tax Identification Number) must be on file with the State Court Administrator’s Office before payments will be processed. In addition, those appointees wishing to have payments made to a law firm instead of to the appointee personally must complete the “Authorization To Pay A Law Firm For Attorney Appointments” form. Contact the Financial Services Division of the State Court Administrator’s Office for copies of these forms. 5. INSTRUCTIONS FOR COMPLETION AND SUBMISSION OF JDF 207 FORM Use Column 1 if only one rate applies during the billing period by completing the total hours billed per category and indicate the rate charged. Use the Third column to indicate Total Charges. If a second rate applies during the billing period, note the hours and rate in Column 2. Then add the hours and charges from Column 1 & 2 per category and complete Column 3. Submit to the court two completed copies including detailed itemizations of hours. In-court attorney hours, out-of-court attorney hours, legal assistant/paralegal/law clerk hours, and other hours as described in the categories listed must be itemized separately. Hours charged must be itemized by date and detailed explicitly as to the activity involved. Abbreviations must be clarified. Requests for payment must include proof of appointment and other documentation as described in Attachment E (Procedures for Payment) of Chief Justice Directive 04-05 and Attachment F (Procedures for Payment) of Chief Justice Directive 04-04. Chief Justice Directives are available at www.courts.state.co.us. Out In Paralegal Sample Detail of Time and Expenses 6/02/07 6/10/07 6/13/07 10/08/07 10/14/07 12/17/07 1/10/08 1/14/08 Court appearance: advisement Conf. w/ parent and caseworker Review social worker report Conf. w/ client Prepare and submit motion for psychological evaluation Court appearance: review hearing Conference in Ft Hoodwink 13 miles 10 copies * .10 cents =$1.00 1.0 2.0 0.5 0.3 0.5 .7 JDF 207 Column 1 from 6/02/07 to 6/30/07 Attorney: 2.5 Out of court hours x $57 = $142.50 1.0 In-court hours x $57 = $ 57.00 Non-Attorney: Paralegal _ hours x $25 = Expenses: miles * .39 before 1/1/08 10 copies x .10 = JDF 207T R1/08 Column 2 from 7/01/07 to 1/14/08 Total hours .3 Out of court hours x $60 = $18.00 .7 In-court hours x $60 = $42.00 .5 hours x $25 = $12.50 13 miles * .46 after 1/1/08 Column 3 Total Amount 2.8 1.7 $160.50 $ 99.00 .5 $ 12.50 $ $ 5.98 1.00 Total Request = $ 278.98 SCAO REQUEST AND AUTHORIZATION FOR PAYMENT OF FEES FOR COUNSEL, GUARDIAN AD LITEM (ADULT REPRESENTATION), NON-ATTORNEY CHIL AND FAMILY INVESTIGATOR, COURT VISITOR, INVESTIGATOR American LegalNet, Inc. www.FormsWorkflow.com