COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.state.ct.us REQUEST FOR JUDICIAL APPROVAL OF COURT FEES IN EXCESS/REIMBURSEMENT OF OTHER EXPENSES:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN RE: (Name of child) JD-JM-146 Rev. 6-03 TO: The Superior Court For Juvenile Matters 1. Prior to exceeding the hourly limit or incurring the relevant expense, complete this form and file with the clerk's office. 2. Upon receipt of Judicial approval to proceed with this case, attach a copy of this form to the JD-JM-132 and a copy of other Requests for each case listed. INSTRUCTIONSDOCKET NO.DATEADDRESS OF COURT (Number, street, town and zip code)PERMISSION IS SOUGHT TO BILL FOR:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ANTICIPATED REPRESENTATION THAT EXCEEDS THIRTY (30) HOURS PURSUANT TO THE AGREEMENT TO PROVIDE LEGAL REPRESENTATION IN JUVENILE MATTERS PROCEEDINGS *(complete section below). ANTICIPATED REPRESENTATION THAT EXCEEDS TWENTY (20) HOURS PURSUANT TO JUDICIAL BRANCH FEE SCHEDULE FOR PANEL REPRESENTATION *(complete section below).THE PEOPLE OF THE STATE OF NEW YORK TOOTHER ALLOWABLE EXPENSES:Court Ordered Testimony Expert Witness Fees Service of Subpoena Fees Transcript FeeGREETINGS:Out-of-state travel Long Distance telephone charges OtherWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County of*DESCRIBE THE SPECIAL CIRCUMSTANCES THAT JUSTIFY FEES IN EXCESS ON THIS CASE:o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.I hereby certify that I have worked for excess hours.previous requestsexcess hours to date on this case. I have made, one of the Justices of theDetailed accounting of hours and case activities is attached.Court in Witness, Honorableday of, 20 County,NAME OF PARTY BEING REPRESENTED & RELATIONSHIPNAME OF INDIVIDUAL ATTORNEY OR LAW FIRMJURIS NUMBER(Attorney must sign above and type name below)ADDRESS OF ATTORNEY/FIRM (Number, street, P.O. Box)TELEPHONEAttorney(s) forCITY/TOWNFAX ZIP CODESTATEE-MAILThe representations contained herein are made under the penalties of false statement:DATE SIGNEDSIGNED (Individual attorney)Office and P.O. AddressXORDER (For Court Use Only)Telephone No.: Facsimile No.: E-Mail Address:DENIED GRANTEDNumber of HoursREQUEST IS HEREBYBY THE COURT (Name of Judge)DATE SIGNED PRINT OR TYPE NAME OF PERSON SIGNING SIGNED (Judge/Asst Clerk),J.Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com