Statement For Payment Of Interpreters
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Statement For Payment Of Interpreters Form. This is a Nebraska form and can be use in General Statewide.
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Tags: Statement For Payment Of Interpreters, 1-8, Nebraska Statewide, General
STATE OF NEBRASKA
FORM NO. 1:8
7/07 Revised
Neb. Rev. Stat. §25-2406
STATEMENT FOR PAYMENT OF INTERPRETERS
Interpreter’s Name: ______________________________________________________
(Print or Type)
Street Address: _________________________________________________________ Check here if new address
City, State, Zip: _________________________________________________________
, or
Social Security Number:
Federal Taxpayer Identification Number:
Language(s)
Day Telephone: (
)__________________
I hereby certify that I served as interpreter as detailed below:
Date
Time
Hours
Rate per
(30 min.
Hour
increments)
Start:
Miles*
County (District, Juvenile or County) Court
or Probation District and County
8
$35.00
End :
Activity:
Start:
8
$35.00
End :
Activity:
Start:
8
$35.00
End :
Activity:
Start:
8
$35.00
End :
Activity:
Start:
8
$35.00
End :
Activity:
Start:
8
$35.00
End :
Activity:
Hours:
Hr.
*Mileage:
miles @ 48.5¢ per mile
**Travel Miles:
Authorizing Signature
Min. @ $35.00/hr
miles ÷ 50 miles × $28
Total Amount Claimed (hr/rate totals + mileage)
=
$
=
$
=
$
=
$
Mail to: State Court Administrator
ATTN: Interpreter
P. O. Box 98910
Lincoln, NE 68509-8910
* Round trip mileage paid @ 48.5¢ per mile if interpreter resides more than 15 miles from where interpreting takes place.
** Travel miles are paid at 80% of the hourly rate for each 50 miles traveled in one day. Calculations based on increments of 50 miles.
Date:
,
Interpreter’s Signature:
Submit between the 1st and the 7th day of the month only. Consolidate statements to as few as possible. Complete all totals for all statements on the
bottom of the first statement. Each entry must have an authorizing signature of a judge, clerk of court, or probation officer. Keep a copy for your records.
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