RECEIPT # _____________ REV. 11/1/11 DEPUTY CLERK _____________ FINANCIAL & CIVIL ALLOTMENT SHEET GENERAL & SPECIAL FUNDS CODE _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 100 101 102 103 104 105 106 107 110 111 112 113 114 118 121 200 201 202 203 204 205 206 301 400 601 700 701 710 ITEM QTY TAPE DUPLICATION MICROFILM/MICROFICHE RECORD SEARCH *(per name) CERTIFICATION OF DOCUMENT DOCUMENT EXEMPLICATION RETURNED CHECK FEE RECORD RETRIEVAL CERTIFICATE OF GOOD STANDING PRO HAC VICE ADMISSION FEE *(per atty/case) FEE _________ _________ _________ _________ _________ _________ COPIES * (per pg) $ 0.50 $ 30.00 $ 6.00 $ 30.00 $ 11.00 $ 18.00 $ 53.00 $ 53.00 $ 18.00 $ 100.00 $ 176.00 $ 15.00 $ ________ $ ________ $ 46.00 $ 350.00 $ ________ $ 5.00 $ 455.00 $ 46.00 $ 46.00 _________ _________ _________ ATTORNEY ADMISSION- GENERAL ATTORNEY ADMISSION- LOCAL *(per yr) _________ PAST DUE ATTORNEY ADMISSION SANCTIONS/ CONTEMPT OF COURT REGISTRATION - FOREIGN JUDGMENT CIVIL FILING FEE PLRA FILING FEE WRIT OF HABEAS CORPUS NOTICE OF APPEAL DOCKETING FEE POWER OF ATTORNEY MISCELLANEOUS FILING FEE APPEAL TO DISTRICT JUDGE FROM CONVICTION BY A MAGISTRATE MISDEMEANOR CASE EMPLOYEE JURY FEE CJA FEE PUBLIC TERMINAL PRINTING FEE * (per pg) _________ _________ _________ _________ CRIMINAL DEBT COST BOND BANK DEPOSIT $ $ $ $ $ $ $ TOTAL 37.00 ________ ________ 0.10 ________ ________ ________ PAYMENT INFORMATION PAYOR: FBO: CASE # : SECTION : CASE CAPTION: PAYMENT TENDERED CASH __________ CHECK# ____________________ SEAMAN _______ CREDIT CARD __________ MONEY ORDER # ____________________ PAUPER ________ TOTAL PAYMENT RECEIVED American LegalNet, Inc. www.FormsWorkFlow.com