JC2000 AC-5067 (REV. 10/04) STATE OF NEW YORK - JUDICIARY APPELLATE DIVISION LAW GUARDIAN VOUCHER Voucher No. _____________________________ DEPARTMENT Originating Agency Code Originating Agency Y Appellate Division, Supreme Court Payment Date (MM) (DD) / P-Contract Interest Eligible (Y/N) (YY) OCS Use Only Liability Date (MM) (DD) (YY) / Payee ID Additional Zip Code Route Payee Amount MIR Date (MM) (DD) (YY) / / Payee Name (Limit to 30 spaces) IRS Code IRS Amount Payee Name (Limit to 30 spaces) Stat. Type Statistic Address (Limit to 30 spaces) Ref/Inv. No. (Limit to 20 spaces) Address (Limit to 30 spaces) Ref/Inv. Date City (Limit to 20 spaces) (Limit to 2 spaces) ÷ State Indicator-Dept. (MM) (DD) Indicator-Statewide (YY) Zip Code Court of, For legal services rendered as Law Guardian pursuant to FCA Art. 2 part 4 in the County from_________________ to ____________________for______________________________________ , docket/index/file number _________________________. INSTRUCTIONS TO LAW GUARDIAN: An Attorney Activity Sheet (see reverse side) must be prepared and the totals transferred to the appropriate categories (I, II, III) below. Both sides must be submitted for payment. Please enter the primary proceeding code (case prefix) and number of petitions covered by this voucher in the appropriate spaces, and check the original voucher in the box below. PROCEEDING CODE: __________ CHECK (T) ORIGINAL VOUCHER ONLY TOTAL HOURS I. AMOUNT TIME SPENT OUT OF COURT NUMBER OF PETITIONS: II. TIME SPENT IN COURT III. __________ EXPENSE OF REPRESENTATION TO BE APPROVED BY JUDGE TOTAL FOR LAW GUARDIAN’S USE: I hereby certify that the above statement of contractual services is true and correct; that no other claim for payment has been made for the time stated therein; and that no part thereof has been paid except as stated therein and that the balance stated is due and owing and that taxes from which the State is exempt are excluded therefrom. STATE COMPTROLLER’S PRE-AUDIT CERTIFIED FOR ______________ Verified SIGNATURE DATE FOR USE OF JUDGE: I hereby certify that in accordance with the above statement of services the total fee awarded for such services is fair and just and is set forth above. SIGNATURE PAYMENT _____________ Audited OF THE TOTAL FEE AMOUNT DATE COUNTY ______________ Special Approval (As Required) By___________________ FOR APPELLATE DIVISION USE ONLY: I hereby certify that this voucher is correct and just and payment is hereby approved. AUTHORIZED SIGNATURE Cost Center Code Dept. Cost Center Unit Var. Yr DATE Object Expenditure Accum Dept. Statewide Liquidation Amount Orig.Agency PO/Contract Line F/P American LegalNet, Inc. www.USCourtForms.com ATTORNEY ACTIVITY SHEET Page:____ Client Name:______________________________________________________________________________ Docket #:________________________ Disposition (last sheet only):___________________________________________________________________________________________________ Date Hours (.10s) O/C I/C Activity Code Hours Activity Codes: I. Out-of-Court A. Review Documents E. Legal Drafting B. Client Interview F. Legal Research C. Travel G. Investigation D. Phone/Correspondence H. All Other Summarize Activities Page Totals II. In-Court J. Initial Appearance L. Fact-Finding K. Pre-trial Hearings M. Disposition N. All Other Expense Amount Expenses III. Other P. Expenses (list along right side of form) (Rev 2.7 10/04) American LegalNet, Inc. www.USCourtForms.com ATTORNEY ACTIVITY SHEET Page:____ Client Name:______________________________________________________________________________ Docket #:________________________ Disposition (last sheet only):___________________________________________________________________________________________________ Date Hours (.10s) O/C I/C Activity Code Hours Activity Codes: I. Out-of-Court A. Review Documents E. Legal Drafting B. Client Interview F. Legal Research C. Travel G. Investigation D. Phone/Correspondence H. All Other Summarize Activities Page Totals II. In-Court J. Initial Appearance L. Fact-Finding K. Pre-trial Hearings M. Disposition N. All Other Expense Amount Expenses III. Other P. Expenses (list along right side of form) (Rev 2.7 10/04) American LegalNet, Inc. www.USCourtForms.com ATTORNEY ACTIVITY SHEET Page:____ Client Name:______________________________________________________________________________ Docket #:________________________ Disposition (last sheet only):___________________________________________________________________________________________________ Date Hours (.10s) O/C I/C Activity Code Hours Activity Codes: I. Out-of-Court A. Review Documents E. Legal Drafting B. Client Interview F. Legal Research C. Travel G. Investigation D. Phone/Correspondence H. All Other Summarize Activities Page Totals II. In-Court J. Initial Appearance L. Fact-Finding K. Pre-trial Hearings M. Disposition N. All Other Expense Amount Expenses III. Other P. Expenses (list along right side of form) (Rev 2.7 10/04) American LegalNet, Inc. www.USCourtForms.com ATTORNEY ACTIVITY SHEET Page:____ Client Name:______________________________________________________________________________ Docket #:________________________ Disposition (last sheet only):___________________________________________________________________________________________________ Date Hours (.10s) O/C I/C Activity Code Hours Activity Codes: I. Out-of-Court A. Review Documents E. Legal Drafting B. Client Interview F. Legal Research C. Travel G. Investigation D. Phone/Correspondence H. All Other Summarize Activities Page Totals II. In-Court J. Initial Appearance L. Fact-Finding K. Pre-trial Hearings M. Disposition N. All Other Expense Amount Expenses III. Other P. Expenses (list along right side of form) (Rev 2.7 10/04) American LegalNet, Inc. www.USCourtForms.com ATTORNEY ACTIVITY SHEET Page:____ Client Name:______________________________________________________________________________ Docket #:________________________ Disposition (last sheet only):___________________________________________________________________________________________________ Date Hours (.10s) O/C I/C Activity Code Hours Activity Codes: I. Out-of-Court A. Review Documents E. Legal Drafting B. Client Interview F. Legal Research C. Travel G. Investigation D. Phone/Correspondence H. All Other Summarize Activities Page Totals II. In-Court J. Initial Appearance L. Fact-Finding K. Pre-trial Hearings M. Disposition N. All Other Expense Amount Expenses III. Other P. Expenses (list along right side of form) (Rev 2.7 10/04) American LegalNet, Inc. www.USCourtForms.com