(TYPE OR PRINT IN BLACK INK) In The General Court Of Justice District Court Division Superior Court Division CAROLINA STATE OF NORTH Capital Charge File No. Additional File Nos. County Name And Address Of Indigent Defendant CAPITAL CASE FEE APPLICATION ORDER FOR PAYMENT JUDGMENT AGAINST INDIGENT Social Security No. - Has No Social Security No. - G.S. Ch. 7A, Art. 36, Art. 37; Ch. 15A NOTE: Use this form for potentially capital cases at the provisional or trial level, and for capital appeals or post-conviction proceedings. Attorneys should consult IDS Rules 2A.4(a), 2B.3, and 2C.3 for deadlines on the submission of final fee applications. INSTRUCTIONS: Applicant completes and signs Section I, and mails to: Office of Indigent Defense Services, 123 W. Main St., Suite 400, Durham, NC 27701. If this is an application for interim payment, the IDS Office will complete Section II and forward a copy of this form to the Administrative Office of the Courts for payment. If this is an application for final payment, the IDS Office will complete Sections II and III, and forward the original form to the trial judge, and copies of the form to the defendant and the AOC for payment. The trial judge then completes Sections IV and V. The Clerk dockets the judgment(s). I. APPLICATION I, the undersigned, am private assigned counsel public defender capital defender provisional counsel appellate defender in this capital case, and make application for payment and reimbursement of necessary expenses incurred, or for determination of value of services rendered for the indigent. I certify that this information is complete and correct to the best of my knowledge. NATURE OF PROCEEDING: Trial Stage (if checked, complete (a) below) Direct Appeal (if checked, complete (b) below) Motion for Appropriate Relief (MAR) (if checked, complete (c) below) Resentencing Only (if checked, complete (a) below) Other (specify): CASE STATUS/TYPE OF DISPOSITION: Complete ONLY the one section below applicable to the fees now being requested: (a) Trial Court, Disposed by Trial, Dismissal or Guilty Plea: (b) Capital Appeals: (check all that apply) Case Pending (interim fee) New Trial (conviction reversed) Case Pending (interim fee) Jury Impaneled Jury Death Qualified No Error Other: (specify) Jury Verdict Mistrial Guilty Plea Guilt Affirmed, Resentencing RESULT: Death Sentence (c) Post-Conviction Or Other: Yes No Life, 1st Degree Murder: Jury sentencing hearing? Case Pending (interim fee) 2nd Degree Murder Vol. Manslaughter Invol. Manslaughter MAR: New Trial Denied Acquitted Dismissed Not Guilty By Reason Of Insanity Resentencing Other Guilty Other Offense(s): (list) Cert. Denied Cert. Granted Other Result: (explain) Other: (specify) FINAL FEES ONLY: Disposition Date Name Of Presiding Judge Check here if you were appointed to represent this defendant in another case(s) at the time of the appointment to this case(s) and you already submitted a fee application for that case(s) in which the $50 attorney appointment fee was charged. Applicant was assistant counsel, case no longer capital IF ATTORNEY IS WITHDefendant retained private counsel DRAWING, indicate reason: Beginning Date THIS Fee Requested Ending Date THIS Fee Requested COMPLETE FOR THIS FEE: Time In Court Time In Court Waiting (attach detailed time sheet) Time must be reported in decimals, not minutes. . Travel List Necessary Expenses Incurred: $ Conflict of interest Other: (specify) PRIOR Total Fees And Expenses Allowed PRIOR Total Hours Allowed $ Time Out Of Court . Applicant's Total Time This Fee . . Long Distance Telephone Copying Other (Specify & Attach Receipt) Total Necessary Expenses This Fee $ $ $ $ NOTE: In assigned counsel cases, the applicant is always the individual attorney appointed in the case. If payment is to be made to applicant individually, write "same" under payee and give applicant's own taxpayer ID No. (Federal Employer ID No. as used by applicant or, if no Federal Employer ID No., SSN). If payment is to be made to applicant's firm, give firm name under payee and give firm's taxpayer ID No. Name Of Applicant Address Payee (see note) Taxpayer ID No. (see note) Telephone No. Date Signature Of Applicant II. AWARD OF PAYMENT OR DETERMINATION OF VALUE OF SERVICES The IDS Director FINDS that the "Total Amount" stated on Line 3 below be: 1. paid by the State of North Carolina to the payee named above. 2. fixed as the value of the legal services and other expenses of representation rendered by the public defender, capital defender, or appellate defender named above. 1. Fees Allowed/Value Of Services Rendered $ 2. Other Necessary Expenses Allowed By The IDS Director $ 3. TOTAL AMOUNT Date $ Signature Of IDS Director IDS Director Thomas K. Maher AOC-CR-425, Rev. 1/09, © 2009 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com III. SUM OF ATTORNEY AND SUPPORT SERVICE FEES AND EXPENSES NOTE: The Office of Indigent Defense Services completes this Section. A. Attorney Fees And Necessary Expenses: SUBTOTAL A (sum of all attorney fees and expenses paid to this attorney, on this and all prior applications) $ B. Support Services Fees And Expenses: (sum of ALL amounts incurred throughout the case) 1. Provisional counsel .................................. $ 2. Psychiatrists, psychologists ..................... $ 3. Medical doctors ........................................ $ 4. Mitigation, investigation................ $ 5. Scientists, forensics, DNA............ $ 6. Sum of all other............................ $ SUBTOTAL B (sum of all support services/expert fees and expenses) GRAND TOTAL A + B (attorney fees and expenses, and support services/experts) $ $ IV. FINDINGS OF FACT AND JUDGMENTS After due notice to the defendant named on the reverse, and opportunity to be heard, the Court finds that the defendant has previously been adjudged to be indigent; that he/she requested and has been provided counsel and other necessary expenses of representation; and that the applicant named on the reverse provided services and incurred expenses of which the money value is that stated in Section III above as to all attorney fees and expenses plus costs for support services and experts incurred in the course of the representation. NOTE: After award of a final fee, the trial court should sign Section V to enter judgments against the defendant for the full GRAND TOTAL in Section III plus the $50 attorney appointment fee. To enter judgments for a different amount, the trial court must fill in the appropriate blanks below. JUDGMENT #1 (Attorney Fees and Expenses) Based on the above findings, it is ORDERED that the State of North Carolina recover from the indigent defendant the GRAND TOTAL in Section III above, together with interest at the legal rate from the date the judgment is docketed until paid, unless one of the following boxes is checked: 1. The defendant was not convicted of a criminal offense and no judgment for attorney fees and expenses shall be entered; or 2. Other: JUDGMENT #2 (Attorney Appointment Fee) It is further ORDERED that the State of North Carolina recover from the indigent defendant the $50 attorney appointment fee pursuant to G.S. 7A-455.1, unless one of the following boxes is checked. 1. The defendant was not convicted of a criminal offense and no judgment for the $50 attorney appointment fee shall be entered; or 2. The attorney named on the reverse was appointed to represent the defendant in another case(s) at the time of the appointment to this case(s), and he or she already submitted a fee application for that case(s) in which the $50 attorney appointment fee was charged (see Section I, "Final Fees Only," on the reverse); or 3. Other: V. SIGNATURE OF JUDGE The foregoing AWARD OF PAYMENT OR DETERMINATION OF VALUE OF SERVICES, as made by the Director of Indigent Defense Services, shall be entered and filed this day in the office of the Clerk of Superior Court. The FINDINGS and JUDGMENTS of the Court shall be entered and filed this day in the office of the Clerk of Superior Court. The Judgments shall become effective as provided by law. Date Name Of Judge (Type Or Print) Signature Of Judge VI. DOCKETING - CSC USE ONLY NOTE: Docket any judgments immediately on the date on which the defendant's conviction becomes final, unless the defendant is ordered as a condition of supervised or unsupervised probation to pay the State for the costs of the defendant's representation. If the defendant is so ordered, docket any judgments immediately on the date the defendant's probation is revoked or terminated by the Court, or when the term of probation expires, whichever occurs first; then docket the amounts owing. Time AM PM Judgment #1 Docket Book And Page No. Abstract No. Amount Docketed Judgment #2 Docket Book And Page No. Date Of Docketing Abstract No. Amount Docketed $ $ AOC-CR-425, Side Two, Rev. 1/09 © 2009 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com