GWINNETT COUNTY INDIGENT DEFENSE INVOICE - EXPERT CASE NUMBER(S) WARRANT NUMBER(S) THE STATE v. CHARGES: APPOINTMENT DATE: DISPOSITION DATE: JURY TRIAL [ ] Guilty [ ] DISMISSED [ ] Not Guilty BENCH TRIAL [ ] Guilty [ ] NOLLE PROSEQUI [ ] DEAD DOCKET [ ] Not Guilty [ ] PLEA [ ] OTHER: Fee Rate per hour $ HRS Attach an itemization of other expenses. Prior approval is required for travel time, food and lodging, photocopying, and the work product of any person other than the expert witness. Travel time is paid at the rate of 48.5 cents per mile and photocopying at the rate of 104 per copy with prior approval. Interview Research Consultation Report Preparation Attach itemizations of any additional expenses and order(s) authorizing expense. APPROVAL IN ADVANCE is mandatory. Conference w/Attorney Submit this invoice and a copy of the judge=s order authorizing the service to the Administrative Office of the Courts 75 Langley Drive Lawrenceville, GA 30045 Questions: 770-822-8541 Trial Preparation Attend Court Other TOTAL $ CLAIMED IN COURT TOTAL $ CLAIMED OUT-COURT INVOICE TOTAL TOTAL OTHER EXPENSES DATE INVOICE SUBMITTED I swear the above claim is true and correct. I further swear that if I appeared in court on the same day on multiple indigent cases, I have prorated the cost of my services. I understand that this invoice is subject to a full audit by the Gwinnett County Indigent Defense Governing Committee. NOTARY SIGNATURE & STAMP EXPERT SIGNATURE DATE: SSN or FEIN NUMBER: YOUR NAME & ADDRESS IN THIS SPACE Do Not Write in This Space for AOC APPROVED: $ by Court Administration Initials DATE: APPROVED: $ by Indigent Defense Governing Committee Initials DATE: AOC FM 6C [Jan 07] American LegalNet, Inc. www.FormsWorkflow.com