Circuit Court Case No. REQUEST FOR PAYMENT OF COURT APPOINTED ATTORNEY FEES STATE OF MICHIGAN COUNTY OF MACOMB 16TH JUDICIAL CIRCUIT District Court Case No. J. Aide Acct. No. Defendant Name PEOPLE OF THE STATE OF MICHIGAN v Attorney Name Bar No. Tax I.D. No. Street Address Phone No. Fax No. City, State, Zip Date of Appointment Macomb County Vendor No. Charge(s)/Type of Case Sentence (Date, Type) I was appointed to represent the defendant in this action. I request payment for the following services pursuant to the indigent fee schedule. (If your request is for simultaneous services in separate case numbers, check the following appropriate blank and reduce the amount requested accordingly. Use a separate form for each case). 2nd simultaneous case (reduce fees by 50%). 3rd 4th simultaneous case, no additional compensation. simultaneous case (reduce fees by 75%). DATE(S) OF SERVICE FEES Initial Preparation: $100.00 Lineup: (In Macomb, $50.00; Out, $100.00) Waiver of Preliminary Exam: $50.00 Plea or dismissal instead of preliminary exam: $100.00 Preliminary Exam: Non-Capital Capital Half-Day Days x $125.00 Days x $150.00 Full Day Days x $175.00 Days x $200.00 Waiver of Circuit Court Arraignment: $50.00 Circuit Court Arraignment/First Conference: $100.00 Pretrial Conference actually conducted: $75.00 Appearance Resulting in Remand to District Court: $50.00 Filing Motion: $50.00 Wade Discovery Remand to District Court Walker Quash Withdraw Plea Expert Witness(es) In Limine Forensic HYTA/7411 Motion Motion to Suppress Other Motion(s): (9/29/09) Page 1 of 2 Request for Payment of Court Appointed Attorney Fees American LegalNet, Inc. www.FormsWorkFlow.com DATE(S) OF SERVICE FEES Research in support of motion: $125.00 (Type of motion: ) Oral Argument on Motion: $75.00 Evidentiary Hearing: Half-Days x $100.00 (Circuit Court, with witness(es), per half-day) Adjournment of event not attributable to defense counsel, where counsel actually appeared Days x $50.00 Guilty Plea (Circuit Court): Non-Capital: $250.00 Capital: $350.00 Circuit Court Trial or Dismissal on Day of Trial: Non-Capital (FH) Cases Days x $350.00 Capital (FC) Cases Days x $500.00 Advisory or Paternity Trial Counsel: Half-Days x $100.00 Full Days x $200.00 Sentence on Date of Plea: $50.00 Sentence on Subsequent Date: $100.00 Deferred Sentence Review Hearing: $100.00 Probation Violation Proceeding: $125.00 Domestic Hearing (no initial preparation fee): $100.00 Appearance at Arraignment on Bench Warrant: $75.00 Extradition Proceedings: Hours x $25.00 I seek compensation for extraordinary services for the reasons set forth in detail in the attached statement (Order signed by judge must be attached): Hours x $25.00 Other Services: Hours x $25.00 (Attach itemized statement) (Order signed by judge must be attached). TOTAL FEES REQUESTED: I understand that payment for extraordinary services is discretionary and may only be available by written motion before the Judge assigned to the case. I have not received compensation from any source in handling this case. I have no expectation of receiving, nor will I accept, any other compensation. I accept the above requested fees as the full and complete payment for services rendered to date in this case. VERIFICATION UNDER MCR 2.114: By checking this box or signing below, I declare that the statements above are true to the best of my information, knowledge, and belief. Signature of Attorney (9/29/09) Date Page 2 of 2 Request for Payment of Court Appointed Attorney Fees American LegalNet, Inc. www.FormsWorkFlow.com