COURT INTERPRETER AUTHORIZATION VOUCHER PAID BY MATTHEW J. DYKMAN, CLERK U.S. DISTRICT COURT 4651 Interpreter ____________________________________________________ Social Security/Tax Number ______________________________________ Mailing Address________________________________________________ City/State/Zip__________________________________________________ is hereby authorized to perform the following interpreting assignment in: Q Spanish Q Navajo Q Other (specify) ____________________, for ___________ day(s) on ________________________________. Check will be made out to above mentioned interpreter unless indicated as follows ______________________________________________________________________________. Hour Date Judge From Case No. Proceeding Defendant and/or Witness – Number To Fee: $____________________ x ____________________ day(s)/half day $ _________________________ Overtime: ____________ hours at ____________________/hour $__________________________ Travel (when applicable)* ___________ miles @ _________¢ / mile $ _________________________ Travel Time: Tolls $__________________________ Court to Home _______________ Rates: Home to Court _______________ Parking $__________________________ CERTIFIED – full day $355 / half day $192 NON-CERTIFIED – full day $171 / half day $92 TRAVEL – 44.5¢ per mile TOTAL $_________________________ I hereby certify under penalty or perjury that the foregoing is true and correct. Date: ________________________ Signature: ______________________________________________ Interpreter *Mileage may be claimed for travel 30 miles or more, one way; rates are as of 1/1/06. Pursuant to authority vested in me, I certify that the voucher is correct and proper for payment. ______________________ (Date) ________________________________________________ (Approved for Payment) __________________________________ (Title) ACCOUNTING CLASSIFICATION _______ - 092000 - DXXBBCX - D10NMX_______ - 2523 American LegalNet, Inc. www.USCourtForms.com