PEOPLE V First Last OAKLAND COUNTY CIRCUIT COURT REQUEST AND ORDER FOR PAYMENT OF COURT APPOINTED COUNSEL (TRIAL LEVEL) Please print or type. Prosecutor Order #______________ Circuit Court #__________________ Circuit Judge___________________ District Court Case #_____________ Bar # P_____________ Attorney Name __________________________________ Address _______________________________________ ______________________________________________ Phone # ____________________ 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 include any adjourned court dates on this sheet. Do not alter time sheet. VOUCHERS MUST BE SUBMITTED TO THE COURT ADMINISTRATOR WITHIN ONE MONTH AFTER DISMISSAL OF THE CASE OR SENTENCING OF YOUR CLIENT [LCR 6.101(B)]. District Court _______________________________________ DATE DISTRICT COURT ACTION Preliminary Exam Waived Conducted HOURS DATE CIRCUIT COURT ACTION Arraignment ( Mail) HOURS Plea of Guilty (Nolo Contendre) Sentence ( Delayed) Plea of Guilty (Nolo Contendre) Sentence ( Delayed) Bench Warrant Issued Dismissal Other _____________________________ Trial (Number of Days ____________) Bench Warrant Issued Dismissal Other__________________________ Circuit Court Use Only Jail Visit (Proof Must be Attached) Lineup APPROVED $ ________________________ DISAPPROVED $ _____________________ KEVIN M. OEFFNER COURT ADMINISTRATOR Polygraph Violation of Probation YTA Revocation Extradition 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. Attorney Signature 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: OFFICE OF THE COURT ADMINISTRATOR OAKLAND COUNTY CIRCUIT COURT 1200 N. TELEGRAPH ROAD, DEPT 404 PONTIAC, MI 48341-0404 Questions? Call Debbie Thompson (248) 858-0255 Fax (248) 975-9877 Additional forms may be obtained from the Court's website: www.oakgov.com OCBD-Atty-voucher-trial.doc Circuit Judge American LegalNet, Inc. www.FormsWorkflow.com Rev 6/06