UNITED STATES DISTRICT COURT LF011 Rev: 1/2018 NORTHERN DISTRICT OF GEORGIA CONTRACT COURT INTERPRETER INVOICE Invoices and necessary receipts shall be submitted within 30 days of the performance of services to: 2211 United States Courthouse / Attn: Budget & Procurement / 75 Ted Turner Drive S.W. / Atlanta, GA 30303-3309 Claims are subject to verification by the court Interpreter Information Case Information Interpreter: USA vs. Certified: Non - Certified: Case# : Language: Presiding Jud g e: Tax ID# of SS#: Requestor : Phone# or Email: *Type of Proceeding: Address: Probation Officer Signature (If Pretrial/Probation Interview): *Type of Proceeding: Initial Appearance, Preliminary Hearing, Arraignment, Trial, Sentencing, Pretrial/Probation Interview, etc. Itemization of Fees and Other Costs Date Service & Travel Time *Fee Mileage Parking **Other Travel Total Cost Begin End Hours Miles Rate Total Explanation for any adjustments: Total Amount Certified for Payment *Fee: Half Day Rate for service & travel time up to 4hrs. Full Day Rate for service & travel time in excess of 4hrs. Meal periods excluded.**Other Travel: Airfare, Hotel, Taxi, Per Diem, etc. Itemize all travel costs on a separate sheet of paper. Attach all receipts for lodging andany other authorized expense of more than $25 for which reimbursement is sought (unless otherwise directed by the Court). Travel Information Location of Service: In Court : Out of Court : Departure Address: Time: Arrival Address: Time: Departure Address: Time: Arrival Address: Time: Explanation for any deviation: Certification I hereby certify that I personally rendered the services described herein for payment requested, that said services were rend ered in accordance with the Contract for Court Interpreter Services, and that no other federal court unit, federal public defender, community defender organization, or other attorneys or entities obtaining interpreting services under the Criminal Justice Act or the related statutes, or the Defender Services appropriation, or any other federal agency or entity has been or will be billed for the same period of service, cancellation or travel expenses for any services rendered during the same half or full-day, other period of service, or time covered by a cancellation fee or travel expense reimbursement for which I am being compensated pursuant to the contract. Signature of Interpreter (Payee) Date Approved For Payment Signature of Presiding Judge Date APPROVED FOR PAYMENT (USDC - NDGA ONLY) Signature: Date Acct Template: $ Acct Template: $ PR#/PO#: P2#: American LegalNet, Inc. www.FormsWorkFlow.com