Defendant Name, Address & Inmate # ___________________________________________ First Last ___________________________________________ ___________________________________________ OAKLAND COUNTY CIRCUIT COURT REQUEST AND ORDER FOR PAYMENT OF COURT APPOINTED COUNSEL (PROSECUTOR APPEAL) Please print or type. Prosecutor Order #______________ 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 For Business Office Extraordinary Fee Use Only 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. REGULAR FEE $ _____________________ Attorney Signature EXTRAORDINARY $ __________________ 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 less any applicable Federal or State Court-ordered and/or statutory lien, levy or garnishment ___________________________________________ dollars from the County Treasury. Please return to: Questions? BUSINESS OFFICE OAKLAND COUNTY CIRCUIT COURT 1200 N. TELEGRAPH ROAD, DEPT 404 PONTIAC, MI 48341-0404 Call (248) 452-2078 Fax (248) 975-9877 Additional forms may be obtained from the Court’s website: www.oakgov.com OCBD-Atty-voucher-appeal form.doc Circuit Judge American LegalNet, Inc. www.FormsWorkFlow.com rev 10/09