UNITED STATES DISTRICT COURT � DISTRICT OF NEBRASKA Transcriber Statement of Services Name/Firm (Payee):___________________________________________Invoice #:_____________________ Address:_________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________ Soc Sec/Tax ID # (Payee):_______________________E-Mail:______________________________________ Phone:_______________________________________Fax:________________________________________ Transcripts: Case Number Judge/Ordered By Date Ordered Date Filed Filing Number Type Number of Pages Rate TOTAL TOTAL $__________________ I certify that I prepared the transcript(s), as claimed above, and that the fees charged are in accordance with the District of Nebraska's Contract for Transcription Services. ________________________________________________________ Transcriber Signature Date Total Amount Claimed $____________________ ___________________________________________________________ Court Reviewer Signature Date Mail Invoice to: Clerk, U.S. District Court th 111 S 18 Plaza, Ste 1152 Omaha, NE 68102-1322 Forms and Court Plans located at www.ned.uscourts.gov Last Revision Date: 9/3/2014 American LegalNet, Inc. www.FormsWorkFlow.com