en-USINVOICE(S) SHALL BE SUBMITTED WITHIN 7 DAYS OF THE SERVICE BEING PROVIDED.en-USFAILURE TO COMPLY WITH THIS REQUIREMENT MAY RESULT IN DELAY. en-USAOC-INT-1 en-USRev. 6-18en-USPage 1 of 2en-USCommonwealth of Kentuckyen-USCourt of Justice en-US www.courts.ky.goven-USAP Part IX, Sections 7 and 15; Uniform en-USPayment Rate for Freelance Interpreters en-USSections I (1) and (2)en-USOFFICE OF LANGUAGE ACCESSen-USSTATEMENT FOR SERVICES lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE en-USDate Received by OLA: en-USen-USTime Period of Invoice:en-USFrom to en-USPage of � � � 1001 Vandalay Drive, Frankfort, KY 40601 � or by e-mail to: FreelanceInterpreterInvoices@kycourts.net. en-USVERIFICATION OF APPOINTING/REQUESTING AUTHORITY � Printed Name of Appointing/Requesting Authority � Signature of Appointing/Requesting Authority � , 2 � County� Date� Title of Appointing/Requesting Authority en-USContract #: Invoice #: Assignment ID #: Name of Interpreter: � Language or Dialect Interpreted: en-US Mailing Address: � Phone Number: � � Email Address: � � County of Residence/Business: en-USTotal Interpreting Time: hours X $ en-US(See Contract Rate) = � $ en-USTotal Travel Time: hours X $ en-USen-US en-US(See Contract Rate) = � $ en-USTotal Reimbursable Lodging Expenses: en-US(OLA Pre-Approval and Receipt Required) = � $ en-USTotal # of Cases Included in this Invoice:en-US en-US(enter 2230224 if none) � en-USINVOICE TOTAL: $ en-USI hereby state the information provided on this form and the payment requested is true to the best of my knowledge.en-USEach charge is supported by relevant orders and receipts. en-USNO OTHER INVOICE HAS BEEN SUBMITTED FOR THESE en-USSERVICES. , 2 � Date � Interpreter Signature American LegalNet, Inc. www.FormsWorkFlow.com en-USen-USen-USen-USen-USen-USen-US Name of Interpreter: � Invoice #: Time Period of Invoice: From to � Contract #: � Page of Use as many page 2 of 2 pages as necessary � 15 min. = .25; 30 min. = .5; 45 min. = .75 en-US*Court Level: CC = Circuit Court; DC= District Court; FC = Family Court; SC = Specialty Court; PS = Pretrial Services; CDW = Court Designated Worker; OT = Other en-USDate ofen-USService en-USAOC-INT-1en-USRev. 6-18en-USPage 2 of 2 en-USCounty ofen-USService en-USTravel Time en-US(If Any) en-USInterpreting Time en-USTotal Time en-US(round to en-USnearest en-US1/4 hour) en-USCase Informationen-US(or Description of Direct Service Provided) en-USName of Person en-USRequiring Services en-USCase # Judge222s Last Name Court Level* en-USStartEnd Subtotal en-USStart End Subtotal or 2 hr min. en-USen-USen-USen-US en-USDate Serviceen-USScheduled en-USType of Serviceen-USScheduled en-USLength ofen-USScheduleden-USService en-USCounty of en-USService en-USDate of en-USCancellation en-USCompensation en-USName of en-USNo-Showen-USParty en-USHoursRateTotal en-USCheck ifen-US en-USNo-Show en-USCANCELLATIONS/NO SHOWS 1001 Vandalay Drive, Frankfort, KY 40601 or by e-mail to: FreelanceInterpreterInvoices@kycourts.net. American LegalNet, Inc. www.FormsWorkFlow.com