STATE OF NORTH CAROLINA In The General Court Of Justice District Superior Court Division County Capital Charge File No. Additional File No(s). Check Here If This Fee Application Covers Multiple Charges Name And Address Of Indigent Defendant Full Social Security No. (required by G.S. 7A-455(d)) CAPITAL CASE FEE APPLICATION ORDER FOR PAYMENT JUDGMENT AGAINST INDIGENT 2A.4(a), 2B.3, and 2C.3 for deadlines on the submission of final fee applications, as well as IDS' billing policies, available at www.ncids.org. 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 IDS Financial Services Office 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 IDS Financial Services Office for payment. The trial judge then completes Sections IV and V. The Clerk dockets the judgment(s). 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 I. APPLICATION I, the undersigned, am private assigned counsel public defender capital defender appellate defender provisional counsel 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) Resentencing Only (if checked, complete (a) below) Direct Appeal (if checked, complete (b) below) Other: (specify) Motion for Appropriate Relief (MAR) (if checked, complete (c) below) CASE STATUS/TYPE OF DISPOSITION: Complete ONLY the one section below applicable to the fees now being requested: (b) Capital Appeals: (a) Trial Court, Disposed by Trial, Dismissal or Guilty Plea: (check all that apply) Case Pending (Interim Fee) Case Pending (Interim Fee) Jury Impaneled Jury Death Qualified No Error Jury Verdict Mistrial Guilty Plea Guilt Affirmed, Resentencing RESULT: New Trial (Conviction Reversed) Death Sentence Other: (specify) Life, 1st Degree Murder: Jury sentencing hearing? Yes No (c) Post-Conviction Or Other: 2nd Degree murder Vol. Manslaughter Invol. Manslaughter Case Pending (Interim Fee) Acquitted Dismissed Not Guilty By Reason Of Insanity MAR: Denied New Trial Resentencing Guilty Other Offense(s): (list) Other: Other Result: (explain) Certiorari Denied Certiorari Granted 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 attorney appointment fee was charged. IF ATTORNEY IS WITHDRAWING, indicate reason: COMPLETE FOR THIS FEE: Applicant was assistant counsel, case no longer capital Defendant retained private counsel Ending Date This Fee Request Time In Court Waiting Conflict of interest Other: (specify) Prior Total Hours Allowed Total Time Claimed This Fee Beginning Date This Fee Request Prior Total Fees And Expenses Allowed Time Out Of Court (Attach detailed time Time In Court sheet. Time must be reported in decimals, Travel not minutes.) $ . . . . Payee and give applicant's taxpayer ID No. (Federal Employer ID No. or, if no Federal Employer ID, SSN). If payment is to be made to applicant's firm, give firm name as Payee and firm's taxpayer ID No. Name Of Applicant Address Payee (see Note) Taxpayer ID No. (see Note) Email Address Telephone No. Date Signature Of Applicant NOTE: In assigned counsel cases, the applicant is always the individual attorney appointed in the case. If payment is to be made to individual applicant, write "same" under $ $ Copying $ Other Total Necessary Expenses This Fee $ 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 $ Date 3. TOTAL AMOUNT IDS Director AOC-CR-425, Rev. 11/14, © 2014 Administrative Office of the Courts Thomas K. Maher Signature Of IDS Director (Over) $ 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 attorney appointment fee. To enter judgments for a different amo