CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR City/County Located at Case No. SPECIAL OFFICER PETITION FOR LEGAL FEES - PANEL ATTORNEY, CRIMINAL CASE For payment, the required Special Officer Final Report - Attorney, Criminal Case (CC-DC-JPR-008) is being submitted with this Petition, and is adopted by reference herein. Defendant Name of Panel Attorney (Type or Print) Firm of Panel Attorney Street/Post Office Address City, State and Zip Code Federal Identification/Social Security Number Court: Charge: If Other (Specify): I. OUT-OF-COURT PREPARATION: Interviews with Client Motions Filed Discovery Suppression Dismiss (Specify) Other (Specify) (hours) II. COURT APPEARANCES: Hearings on Motions Pre-Trial Conferences Other Pre-Trial Preliminary Hearing Arraignment Plea Trial Sentence Hearing Other (Specify) TOTAL IN-COURT HRS.: II. Yes No III. (hours) TOTAL OUT-OF-COURT HRS.: I. III. EXPENSES: Please submit a separate statement, on letterhead, of any expenses you have incurred, along with appropriate receipts, if available. TOTAL EXPENSES: CERTIFICATION: I hereby certify that the above hours and expenses are true and accurate and that compensation has not been received. I also certify that no payment or promise of payment has been requested or accepted for representing the above Defendant. Signature of Attorney CPF ID No. Date Telephone Number Fax E-mail CC-DC-JPR-007 (10/2015) American LegalNet, Inc. www.FormsWorkFlow.com