U.S. District Court, District of New Mexico Contract Interpreter Authorization Voucher Interpreter: Social Security/Tax ID Number: Mailing Address: City/State/Zip: PAID BY MATTHEW J. DYKMAN, CLERK U.S. DISTRICT COURT 4651 Contract/BPA Number: I hereby request payment be made for interpretation services requested and performed in: Spanish Navajo Yes No Other (specify) AO Certified or Professionally Qualified? Check will be made out to above named interpreter unless indicated as follows: TIME DATE From To Judge, U.S. Probation Officer or U.S. Pretrial Officer NUMBER OF DEFENDANTS OR WITNESSES CASE NO. PROCEEDING RATES: Certified and PQ: Non-Certified: Full Day Half Day $ 412 $ 223 $ 198 $ 109 OT/hr $ 58 $ 34 Continue on page 2 if necessary 1a. Day(s): 1b. Half Day(s): 2. Overtime Hr(s): x x x per full day per half day per hour OT 1. Fees (a+b) 2. Overtime 3. Mileage Line 4 and 5: Overnight trips only -- totals must match corresponding fields on Itemized Travel Voucher. 3a. Mileage (when authorized *) x $ .575 per mile * Must be 30 miles or more, one way. Include date and times of departure/arrival, below. Departure from residence Arrival at court destination Departure from court location Arrival at residence 4. Transportation 5. Subsistence 6. Other TOTAL I certify that I rendered the services described herein, that said services were rendered in accordance with the Contract Court Interpreter Services Terms and Conditions, and that no other federal court unit, Federal Public Defender, Community Defender Organization, or other attorneys or entities obtaining interpreting services under the CJA of the Defender Services appropriation has been or will be billed for the same period of service, cancellation or travel expenses. Signature: Pursuant to the authority vested in me, I certify that the voucher is correct and proper for payment. Approved for Payment: Title: ACCOUNTING CLASSIFICATION Date: Date: ______ - 092000 - _____ XXBBCX - D10NMX - _____ - 2523 Rev. 12/31/2014 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Contract Interpreter Authorization Voucher Interpreter: Page 2 of 2 TIME DATE From To Judge, U.S. Probation Officer or U.S. Pretrial Officer CASE NO. PROCEEDING DEFENDANT OR WITNESS NUMBER Rev. 12/31/2014 American LegalNet, Inc. www.FormsWorkFlow.com