Defendant Name, Address & Inmate # First Last Prosecutor Order # Oakland County Circuit Court Request and Order for Payment Of Court Appointed Counsel (Appeal) Please print or type. Court of Appeals # Circuit Court # Circuit Judge Attorney Name Phone # Bar # P Address Vendor ID # Appointment Date Charge(s) The above-named attorney was appointed to represent the defendant. A complete and accurate record of services rendered appears on the time sheet below. DO NOT ALTER TIME SHEET. Michigan Court of Appeals Michigan Supreme Court Conviction From a Plea Conviction From a Trial DATE ACTION HOURS DATE ACTION HOURS Preparation of Brief Number of Pages of Trial Transcript Written Motions Oral Argument Prison Visit – Region TOTAL HOURS I have not received compensation from any source for handling this case. I have no expectation of receiving, nor will I accept, any other compensation. Circuit Court Use Only Attorney Signature APPROVED $ KEVIN M. OEFFNER COURT ADMINISTRATOR Transcript Sent to Defendant: Yes No APPEAL IT IS ORDERED: ORDER The above named attorney was appointed to represent this defendant in the above-captioned case. (S)he has rendered this service, filed a payment voucher, and shall be paid __________________________________________________ dollars from the County Treasury. Please Return to: Question? Call Linda Russell OFFICE OF THE COURT ADMINISTRATOR OAKLAND COUNTY CIRCUIT COURT 1200 N TELEGRAPH ROAD DEPT 404 PONTIAC MI 48341-0404 (248) 452-2078 Fax (248) 975-9877 Additional forms may be obtained from the Court's website: www.oakgov.com OCBD-Atty-voucher-appeal.doc Circuit Judge rev.12/06 American LegalNet, Inc. www.FormsWorkflow.com