APPENDIX A Instructions for Completing Motion, Entry, and Certification for Appointed Counsel Fees Form OPD-1026R The following instructions are for the Motion, Entry, and Certification for Appointed Counsel Fees form (OPD-1026R). For the purpose of these instructions, the form is divided into eight sections, A - H, and spaces requiring an entry have been numbered. TO BE COMPLETED BY THE ATTORNEY Section A (1) Enter the name of the court in which the services are being rendered. Appropriate entries in this space are limited to the following: • • • (2) Common Pleas Municipal Domestic Relations • • • Juvenile County Appeals Enter the name of the county or city in which services are being rendered. The following are examples of how the completed line might read: • • • • • • (3) In the Common Pleas Court of Montgomery County, Ohio In the Juvenile Court of Cuyahoga County, Ohio In the Municipal Court of Akron, Ohio In the County Court of Erie County, Ohio In the Appeals Court of Butler County, Ohio In the Domestic Relations Court of Madison County, Ohio Clearly identify the plaintiff. If the plaintiff is the State of Ohio, write “State of Ohio” in this space. If the plaintiff is a municipality, village, etc., write in the name of the city, village, etc. The following are examples of how entries in this space might read: • • • State of Ohio City of Akron Village of Arlington If there is no plaintiff, leave this space blank. (4) Enter the name of the defendant or the party being represented. (5) Complete the “In re:” section, if applicable, for juvenile cases. (6) Enter the case number. If it is an appeals case, see (7) below. -23American LegalNet, Inc. www.USCourtForms.com APPENDIX A (23) Indicate how the charge was disposed. Use only the following categories: • • • • • • • • • • • • • • Pled: Client pleads guilty, no contest, or admits to the charge. Lesser: Client pleads guilty, no contest, or admits to a lesser charge. TG: Trial - found guilty/delinquent/unruly. TN: Trial - found not guilty/delinquent/unruly. TO: Trial - other (hung jury, etc.). Dismissal: The case is dismissed by the judge hearing the case. Other: Any other types of case disposal. WD: Counsel withdrew from case TC: Agency is given temporary custody. PC: Agency is given permanent custody. PS: Child is placed under protective supervision. CD: Custody is denied to agency. AFF: Affirmed REV: Reversed (24) The figures for the boxes in the Summary of Hours, Expenses, and Billing grid are to be copied from the grand totals in Section (G) of side two of this form. The figures show the total number of hours spent on each type of service provided, and the total number of hours spent out-of-court and in-court. See Section (G) on side two of the form for a listing of the different types of services and their associated numbers. (25) Check this box if a flat fee is used. When a flat fee is used, the attorney must still record the number of hours of service. (26) Check this box if a minimum fee is used. When a minimum fee is used, the attorney must still record the number of hours of service. Note: see Section (F) of the State Maximum Fee Schedule for new standards regarding minimum fees. (27) Enter the total number of in-court hours. (28) Enter the county’s in-court hourly rate. (29) Enter the product of the total in-court hours and county hourly rate for in-court services. (30) Enter the total number of out-of-court hours. (31) Enter the county’s out-of-court hourly rate. (32) Enter the product of the total out-of-court hours and the county hourly rate for out-ofcourt services. (33) Enter the sum of the in-court and out-of-court totals for legal fees. (34) Enter the total expenses incurred in the representation of the client. This figure should be copied from the grand total in Section (H) on side two of the form. (35) Enter the grand total of legal fees plus expenses being requested. -25American LegalNet, Inc. www.USCourtForms.com APPENDIX A Section (D), Judgment Entry, and Section (E), Certification are to be completed by the court and by the county respectively. If local practice permits, the attorney may complete (44) and (45) in the Judgment Entry section before submitting the form to the court. Section F (36) Enter the case number. If the case is an appeal, be sure to enter the appellate case number rather than the lower court case number. (37) Enter the name of the attorney. (38) If the case is a Capital Offense case, enter the name of co-counsel for the case. Be sure the box on the front of the form is checked. See Section (A)(9). Section G (39) Complete the Itemized Fee Statement grid according to the following guidelines: • Use only the Itemized Fee Statement to record hours worked in- and out-of-court. If additional space is needed, use form OPD-1027R, Itemized Fee Statement Continuation Sheet. If form OPD-1027R is used, put the grand total of all hours worked only on the last continuation sheet used. Per page totals are not necessary. Otherwise, put the grand total in the “Grand Total” row of the Itemized Fee Statement on form OPD-1026R. Grand totals must also be recorded in the “Grand Total Hours” row on the front of the form. • For each date services were performed, enter in the appropriate boxes the date of service, the number of hours spent performing each type of service, and the total hours. On the form, two sets of columns are provided. When the bottom of the first set of columns is reached, continue at the top of the second. Use continuation sheets in the same manner. • Record all out-of-court hours in the "Out-of-Court Total" column. There are no longer separate out-of-court categories. • For in-court hours, specify time between two categories: "pre-trial hearings" and "all other in-court", then add the two and enter the sum in the "In-Court Total" column. • Add the out-of-court total and the in-court total and enter the sum in the "Daily Total" column. • In the Grand Total row, enter the sum of each column. • Be sure to enter a number for hours of service performed. Entering a check mark, an “X,” or other non-numerical markings is not allowed. Hours are to be itemized in tenth of an hour (6 minute) increments. -26American LegalNet, Inc. www.USCourtForms.com APPENDIX A • Attorneys are also required to prepare and maintain time records for each appointed case showing the date of service, nature of services rendered, and hours worked. These records should not be turned in with the billing, but may be requested from the attorney in the event that the court or the Ohio Public Defender has questions about the billing. The suggested format for maintaining such time is on form OPD1028: Attorney Time Log. Using this form is optional. Attorneys may use their own forms or billing programs so long as equivalent data can be produced, if requested. Records should be kept for five years after the date the Motion, Entry, and Certification form is submitted to the court for payment. Section H The following instructions detail the completion of one line (one expenditure) of the Itemized Expense grid. Please continue to enter information into the grid (if necessary) in the same manner for additional expenditures. If additional lines for recording expenses are necessary, use an additional sheet of paper. Do not record a per page total or grand total of expenses on the additional sheet. Per page totals are not necessary. The grand total must appear only in spaces (33) and (43) of the Itemized Expense grid on form OPD-1026R. (40) Assign a category using one of the six categories listed above the grid. Use only these categories. (41) Enter the name of the individual or organization to which the expense was paid. (42) Enter the total amount (include applicable taxes) of the expense. (43) After all expenses have been entered, write the grand total in this space. This is the total dollar amount of expenses that will be used in determining the total billing amount. Be sure to attach a receipt for each expenditure over $1.00 when required. Please refer to Section (P) of the Ohio Public Defender Standards and Guidelines for Appointed Counsel Reimbursement for a detailed listing of reimbursable expenses. TO BE COMPLETED BY THE COURT Section D (44) Enter the name of the county. (45) Enter the dollar amount of fees and expenses approved by the court. (46) Check the box if the court has granted extraordinary fees for this case. Be sure to attach a copy of the relevant journal entry if extraordinary fees have been granted. (47) The judge hearing the case must sign and date the form. -27American LegalNet, Inc. www.USCourtForms.com APPENDIX A TO BE COMPLETED BY THE COUNTY Section E (48) Enter the county number (1-88). (49) Enter the number of the warrant issued to the attorney. (50) Enter the date the warrant was issued. (51) The county auditor must sign or stamp the form. -28American LegalNet, Inc. www.USCourtForms.com Section A MOTION, ENTRY, AND CERTIFICATION FOR APPOINTED COUNSEL FEES In the ________________(1)______________________ Court of __________________(2)___________________, Ohio (3) Plaintiff: Case No. ______________(6)________________________ Appellate Case No. (if app.) ___________(7)_____________ v. _____________________(4)_________________________ Defendant/Party Represented (8) ? Capital Offense Case (check if Capital Offense case) (9) ? Guardian Ad Litem (check if appointed as GAL) In re: _________________(5)_________________________ Judge: _________________(10)_______________________ Section B MOTION FOR APPROVAL OF PAYMENT OF APPOINTED COUNSEL FEES AND EXPENSES The undersigned having been appointed counsel for the party represented moves this Court for an order approving payment of fees and expenses as indicated in the itemized statement herein. I certify that I have received no compensation in connection with providing representation in this case other than that described in this motion or which has been approved by the Court in a previous motion, nor have any fees and expenses in this motion been duplicated on any other motion. I, or an attorney under my supervision, have performed all legal services itemized in this motion. (11) ? Periodic Billing (check if this is a periodic bill) As attorney/guardian ad litem of record, I was appointed on _________(12)__________, _______. This case terminated and/or was Disposed of on ________(13)___________, _______. I am submitting this application on _________(14)____________, _______. Name________________(15)__________________________ Signature_______________________(16)_____________________ Address_____________________(17)__________________________________________ No. and Street City Section C State SSN/Tax ID_______(18)__________ OSC Reg. No. _____(19)__________ SUMMARY OF CHARGES, HOURS, EXPENSES, AND BILLING OFFENSE/CHARGE/MATTER ORC/CITY CODE DEGREE DISPOSITION (21) (22) (23) (20) 1.) Zip 2.) 3.) *List only the three most serious charges beginning with the one of greatest severity and continuing in descending order. (24) Grand Total Hours From Other Side: OUT-OF-COURT PRE-TRIAL HEARINGS IN-COURT ALL OTHER IN-COURT IN-COURT TOTAL GRAND TOTAL (25) Flat Fee Hrs:In __(27)___ X Rate __(28)__ = $____(29)_____ Tot. Fees $____(33)___ (26) Min Fee Hrs:Out __(30)___ X Rate __(31)__ = $____(32)_____ Expenses $____(34)___ Section D Total $____(35)___ JUDGMENT ENTRY The Court finds that counsel performed the legal services set forth on the itemized statement on the reverse hereof, and that the fees and expenses set forth on this statement are reasonable, and are in accordance with the resolution of the Board of County Commissioners of ____________(44)_______________ County, Ohio relating to payment of appointed counsel, that all rules and standards of the Ohio Public Defender Commission and State Public Defender have been met. IT IS THEREFORE ORDERED that counsel fees and expenses be, and are hereby approved, in the amount of $_____(45)_______. It is further ordered that the said amount be, and hereby is, certified by the Court to the County Auditor for payment. (46)? Extraordinary fees granted (copy of journal entry attached) Section E Judge ____________________(47)_______________________ Signature Date CERTIFICATION The County Auditor, in executing this certification, attests to the accuracy of the figures contained herein. A subsequent audit by the Ohio Public Defender Commission and/or Auditor of the State which reveals unallowable or excessive costs may result in future adjustments against reimbursement or repayment of audit exceptions to the Ohio Public Defender Commission. County Number _______(48)_________ Warrant Number _______(49)________ Warrant Date _______(50)_________ County Auditor _____________________(51)____________________________ American LegalNet, Inc. www.USCourtForms.com Section F CASE NUMBER ____________(36)______________ ATTORNEY/GAL ___________(37)_______________ IF CAPITAL OFFENSE CASE, LIST CO-COUNSEL'S NAME HERE: _______________(38)_________________ ITEMIZED FEE STATEMENT I hereby certify that the following time was expended in representation of the defendant/party represented: IN-COURT TOTAL IN-COURT DAILY TOTAL DATE OF SERVICE (continued) OUT- OFCOURT TOTAL PRE-TRIAL HEARINGS ALL OTHER IN-COURT OUT- OFCOURT TOTAL DATE OF SERVICE PRE-TRIAL HEARINGS IN-COURT ALL OTHER IN-COURT Section G DAILY TOTAL IN-COURT TOTAL (39) GRAND TOTAL Continue at top of next column. Time is to be reported in tenth of an hour (6 minute) increments. Section H I hereby certify that the following expenses were incurred: Use the following categories for Type: TYPE (40) (1) Experts (2) Postage/Phone (3) Records/Reports (4) Transcripts PAYEE (5) Travel (6) Other AMOUNT (41) (42) TOTAL (43) Clearly identify each expense and include a receipt for any expense over $1.00. See Section (P)(1)(c) for privileged information. American LegalNet, Inc. www.USCourtForms.com APPENDIX B Instructions for Completing Supreme Court of Ohio Motion, Entry, and Certification for Appointed Counsel Fees Form OPD-E-1031 The following instructions are for the Supreme Court of Ohio: Motion, Entry, and Certification for Appointed Counsel Fees form (OPD-E-1031). For the purpose of these instructions, the form is divided into five sections, A - E, and spaces requiring an entry have been numbered. TO BE COMPLETED BY THE ATTORNEY Section A (1) Enter the name of the defendant. (2) Enter the case number assigned by the Supreme Court. (3) Enter the case number assigned by the Appeals Court. (4) Enter the case number assigned by the Trial Court. Section B (5) Enter the number of in-court hours claimed. This number must equal the total number of in-court hours listed in the space provided on side two of the form. (6) Enter the number of out-of-court hours claimed. This number must equal the total number of out-of-court hours listed in the space provided on side two of the form. (7) Enter the total amount for expenses other than legal fees. This amount must match the total of all expenses listed in the space provided on side two of the form. (8) List the offense(s), the degree of the offense(s), and the applicable R.C. Section being considered in the appeal. If there are more than three charges against the client, list only the three most serious charges beginning with the one of greatest severity and continuing in descending order. (9) Enter the decision handed down by the Supreme Court at the termination of the case. (10) Enter the date on which the case was terminated by the Supreme Court. (11) Enter the name of the attorney. (12) Enter the social security or federal tax ID number of the attorney. (13) The attorney must sign the form in this space. (14) Enter the mailing address of the attorney. -31American LegalNet, Inc. www.USCourtForms.com APPENDIX B Section (C), Judgment Entry, and Section (D), Certification are to be completed by the court and by the county respectively. The attorney should not write in these sections. Section E (24) For each activity, enter the date, type of activity, and total time. Time must be recorded in tenth of an hour (6 minute) increments. (25) For each expense, enter the type of expense, the name of the individual or organization to which the expense was paid, and the amount of the expense. Reimbursement for expenses shall be made pursuant to Section (P) of the Ohio Public Defender Standards and Guidelines for Appointed Counsel Reimbursement. (26) The attorney must sign the back of the form in the space provided. TO BE COMPLETED BY THE COURT Section C (15) Enter the dollar amount of fees approved by the court. (16) Enter the dollar amount of expenses approved by the court. (17) Enter the sum of the fees and expenses approved by the court. This is the total amount that will be paid to the attorney. (18) Enter the name of the county responsible for paying the attorney fees and expenses. (19) The Chief Justice of the Supreme Court must sign the form. TO BE COMPLETED BY THE COUNTY Section D (20) Enter the county number (1 - 88). (21) Enter the number of the warrant issued to the attorney. (22) Enter the date the warrant was issued. (23) The county auditor must sign or stamp the form. -32American LegalNet, Inc. www.USCourtForms.com Section A SUPREME COURT OF OHIO MOTION, ENTRY, AND CERTIFICATION FOR APPOINTED COUNSEL FEES State of Ohio, Plaintiff, Supreme Court No. __________(2)_________ Appeals Court No. ___________(3)_________ V. Trial Court No. ______________(4)__________ ___________________(1)______________________ Defendant Section B MOTION FOR APPROVAL OF PAYMENT OF APPOINTED COUNSEL FEES AND EXPENSES The undersigned, having been previously appointed counsel for the defendant for the appeal to this court, as evidenced by the attached entry of appointment, now moves for an order approving payment of fees earned and expenses incurred as reflected by the itemized statement of the reverse hereof, pursuant to R.C. 2941.51. IN COURT (5) Hours Worked: OUT OF COURT (6) Expenses (if any): $ (7) O.R.C. charge section number, name and classification A. (8) B. C. SUPREME COURT DECISION TERMINATION DATE (9) ATTORNEY’S NAME SOC. SEC. NO. (11) ATTORNEY’S ADDRESS (10) ATTORNEY’S SIGNATURE (12) (13) NUMBER AND STREET CITY STATE ZIP (14) INFORMATION BELOW TO BE COMPLETED BY SUPREME COURT AND COUNTY AUDITOR ONLY Section C JUDGMENT ENTRY This court finds that counsel performed the legal services set forth in the itemized statement on the reverse hereof, and that the fees and expenses hereinafter approved are reasonable. IT IS THEREFORE ORDERED that appointed counsel fees are approved in the sum of $ ____________(15)___________ and expenses in the sum of $___________(16)____________ for a total allowance of $_____________(17)___________, which amount is ordered certified to the ____________(18)____________ County Auditor for payment. __________________(19)__________________ CHIEF JUSTICE Section D CERTIFICATION The County Auditor, in executing this certification, attests to the accuracy of the figures contained herein. A subsequent audit by the Ohio Public Defender Commission and/or Auditor of the State which reveals unallowable or excessive costs may result in future adjustments against reimbursement or repayment of audit exceptions to the Ohio Public Defender Commission. COUNTY NUMBER WARRANT NUMBER (20) WARRANT DATE (21) (22) COUNTY AUDITOR (23) American LegalNet, Inc. www.USCourtForms.com Section E I hereby certify that the following time was expended in representation of the defendant before the Supreme Court of Ohio: DATE ACTIVITY TOTAL TIME (24) Time is to be recorded in tenth of an hour (6 minute) increments. EXPENSE PAID TO AMOUNT (25) To obtain reimbursement, the purpose of each expense must be clearly identified, and a receipt provided for each expenditure over $1.00. I hereby certify the above is a true and accurate account of the time spent and expenditures incurred in representing the defendant in the Supreme Court of Ohio. __________________(26)____________________ Applicant’s Signature OPD-1031 (rev 8/95) American LegalNet, Inc. www.USCourtForms.com APPENDIX C Instructions for Completing Clerk’s / Auditor’s Transcript Fee for an Indigent Defendant Form OPD-E-205 The following instructions are for the Clerk’s/Auditor’s Transcript Fee for an Indigent Defendant form (OPD-E-205). For the purpose of these instructions, the form is divided into four sections, A - D, and spaces requiring an entry have been numbered. TO BE COMPLETED BY THE CLERK OF COURTS Section A (1) Enter the name of the court in which the case was heard. Appropriate entries in this space are limited to the following: • • • • Common Pleas Municipal Domestic Relations Supreme • • • Juvenile County Appeals (2) Enter the name of the county or city in which services are being rendered. (3) Clearly identify the plaintiff. If the plaintiff is the State of Ohio, write “State of Ohio” in this space. If the plaintiff is a municipality, village, etc., write the name of the city, village, etc. in the space. The following are examples of how entries in this space might read: • • • State of Ohio City of Akron Village of Arlington If there is no plaintiff, leave this space blank. (4) Enter the name of the defendant or the party being represented. (5) In juvenile cases, complete the “In re:” section, if applicable. (6) Enter the case number. (7) Enter the name(s) of the attorney(s). Section B (8) Enter the name of the official court stenographer. -35American LegalNet, Inc. www.USCourtForms.com APPENDIX C (9) Enter the tax identification number of the official court stenographer. (10) Describe the nature of the transcript being ordered. (11) The clerk of courts must sign the form in the space provided. (12) The clerk of courts must date the form in the space provided. (13) Put a check mark or “X” in front of one of the seven categories indicating the type of proceeding for which the transcript was ordered. (14) Enter the number of pages in the original transcript. (15) Enter the per page rate for the original transcript. (16) Enter the cost of the original transcript (cost = number of pages x per page rate). (17) Enter the number of pages in the copy of the transcript. (18) Enter the per page rate for the copy of the transcript. (19) Enter the cost of the copy of the transcript (cost = number of pages x per page rate). (20) Enter the total transcript fees being billed. Section C (21) Enter the total transcript fees approved by the court. (22) Print or type the name of the judge hearing the case or proceeding for which the transcript is being ordered. (23) The judge must sign and date the form in this space. TO BE COMPLETED BY THE COUNTY Section D (24) Enter the county number. (25) Enter the number of the warrant issued to the official stenographer. (26) Enter the date the warrant was issued. (27) The county auditor must sign or stamp the form in this space. -36American LegalNet, Inc. www.USCourtForms.com Section A CLERK’S/AUDITOR’S TRANSCRIPT FEE FOR AN INDIGENT DEFENDANT Revised Code 2301.24-25 In the _______________(1)____________________Court of ________________(2)___________________,Ohio. Plaintiff: (3) Case No. ______________(6)_________________ v. ___________________(4)______________________ Defendant/Party Represented Attorney(s) for the Defendant/Party Represented: In re:_______________(5)______________________ _________________________________________ ____________________(7)___________________ CLERK OF COURTS CERTIFICATION Section B I, the Clerk of Courts, hereby certify that ___________(8)_________________, ______________(9)______________,is (Court Reporter’s Name) (Court Reporter’s Tax ID) hereby an official stenographer of said court and is entitled to the following fees for making transcript(s) of: ______________________________________(10)_______________________________________________________ _______________(11)_________________________ Clerk’s Signature ____________________(12)____________________ Date The transcript is ordered by the court for use by the Defendant or the Defendant’s attorney in the following type of proceeding: (13) _____ Felony, misdemeanor, or juvenile proceeding _____ Capital Offense trial proceeding _____ Appeals proceeding _____ Capital Offense appeals proceeding _____ Postconviction proceeding _____ Capital Offense postconviction proceeding _____ Other (explain) __________________________________________________________ Date which above checked proceeding terminated: ____________________ OR ? Still Pending (check if pending) Original transcript of ____(14)_____ pages or folio at the rate of $___(15)_____ per page or folio, = $_____(16)______ Copy of transcript of ____(17)_____ pages or folio at the rate of $___(18)_____ per page or folio, = $_____(19)______ TOTAL $_____(20)______ NOTE: A COPY OF THE COURT REPORTER’S BILLING MUST BE ATTACHED JUDGMENT ENTRY Section C The court finds that the transcript was ordered for use in the case of an indigent person, that all rules and standards of the Ohio Public Defender Commission and the Ohio Public Defender have been met and that a Financial Disclosure/Affidavit of Indigency form for the above referenced client has been sent to the Office of the Ohio Public Defender or is attached to this document. IT IS THEREFORE ORDERED that the transcript fees be, and are hereby approved in the amount of $_______(21)________. It is further ordered that the said amount be, and hereby is, certified by the Court to the County Auditor for payment. ________________(22)___________________ Judge’s Name (type or print) Section D _______________(23)___________________________________ Judge’s Signature Date CERTIFICATION The County Auditor in executing this certificate attests that the transcript was a true and accurate expense of said county's court. County Number _____(24)______ OPD-E-205 Rev. (11//96) Warrant Number ______(25)______ Warrant Date ______(26)______ ______________________(27)_______________________ County Auditor’s Signature American LegalNet, Inc. www.USCourtForms.com APPENDIX D Instructions for Completing Request for Court Paid Experts and/or Expenses Form OPD-209 The following instructions are for the Request for Court Paid Experts and/or Expenses form (OPD-209). For the purpose of these instructions, the form is divided into three sections, A, B and C, and spaces requiring an entry have been numbered. TO BE COMPLETED BY THE COURT Section A (1) Enter the name of the court in which the services are being rendered. Appropriate entries in this space are limited to the following: • • • Common Pleas Municipal Domestic Relations • • • Juvenile County Appeals (2) Enter the name of the county or city in which services are being rendered. (3) Clearly identify the plaintiff. If the plaintiff is the State of Ohio, write “State of Ohio” in this space. If the plaintiff is a municipality, village, etc., write in the name of the city, village, etc. If there is no plaintiff, leave this space blank. (4) Enter the name of the defendant or the party being represented. (5) Complete the “In re:” section, if applicable, for juvenile cases. (6) Enter the case number. (7) Enter the name of the attorney(s) for the defendant or party represented. Section B (8) Enter the name of the offense with which the defendant was initially charged or for which the defendant was indicted. (9) Enter the ORC Section or Municipal Ordinance Section. (10) Enter the degree of the offense (e.g., F1, M4, etc.). (11) Indicate how the offense was disposed. Use only the following fourteen categories: • • • • • Pled: Client pleads guilty, no contest, or admits to the charge. Lesser: Client pleads guilty, no contest, or admits to a lesser charge. TG: Trial - found guilty/delinquent/unruly. TN: Trial - found not guilty/delinquent/unruly. TO: Trial - other (hung jury, etc.). -39American LegalNet, Inc. www.USCourtForms.com APPENDIX D • • • • • • • • • Dismissal: The case is dismissed by the judge hearing the case. Other: Any other types of case disposal. WD: Counsel withdrew from case TC: Agency is given temporary custody. PC: Agency is given permanent custody. PS: Child is placed under protective supervision. CD: Custody is denied to agency. AFF: Affirmed REV: Reversed Section C (12) Enter the amount of the approved expert fees or expenses being paid directly by the court. (13) Type or print the name of the judge presiding over the case. (14) The judge presiding over the case must sign and date the form. TO BE COMPLETED BY THE COUNTY AUDITOR Section D (15) Enter the name of the payee. (16) Enter the payee's tax identification number. (17) Enter the warrant date of the warrant issued to the payee. (18) Enter the warrant number issued to the payee. (19) Enter the amount paid to the payee. (20) Enter the total of all warrants paid. (21) Enter the county number (1-88). (15) The County Auditor must sign or stamp the form. -40American LegalNet, Inc. www.USCourtForms.com REQUEST FOR COURT PAID EXPERTS AND/OR EXPENSES Section A In the ________________(1)_________________ Court of ________________(2)_______________ , Ohio. Plaintiff: (3) Case No.______________(6)__________________ Attorney(s) for the Defendant/Party Represented: v. __________________(4)______________________ Defendant/Party Represented ___________________(7)_____________________ In re: _____________(5)______________________ __________________________________________ Section B CHARGES OFFENSE/CHARGE/MATTER ORC/CITY CODE DEGREE DISPOSITION (9) (10) (11) (8) 1.) 2.) 3.) *List only the three most serious charges beginning with the one of greatest severity and continuing in descending order. JUDGMENT ENTRY Section C The Court finds that the following experts and/or expenses were ordered for use in the case of an indigent person, that all rules and standards of the Ohio Public Defender Commission and State Public Defender have been met, and that a Financial Disclosure/Affidavit of Indigency Form for the above referenced person has been sent to the Office of the Ohio Public Defender, or is attached to this document. IT IS THEREFORE ORDERED that the expert fees and/or expenses attached are hereby approved in the amount of $______(12)_______. It is further ordered that the said amount is certified by the Court to the County Auditor for payment. _________________(13)_____________________ Judge's Name (type or print) Section D _____________________(14)__________________ Judge's Signature Date COUNTY AUDITOR'S CERTIFICATION The County Auditor in executing this certificate attests to the accuracy of the figures contained herein. A subsequent audit by the Ohio Public Defender Commission and/or Auditor of State that reveals unallowable or excessive costs may result in future adjustments against reimbursement or repayment of audit exceptions to the Ohio Public Defender. PAYEE TAX ID (15) WARRANT NO. WARRANT DATE AMOUNT (16) (17) (18) (19) (If necessary, continue on separate sheet.) County Number ________(21)_______________ TOTAL (20) __________________(22)______________ County Auditor's Signature OPD-209 (1/00) American LegalNet, Inc. www.USCourtForms.com APPENDIX E Instructions for Completing Financial Disclosure/Affidavit of Indigency Form OPD-206R The following instructions are for the Financial Disclosure/Affidavit of Indigency form (OPD206R). The form is divided into ten sections, I-X. For the purpose of these instructions, spaces requiring an entry have been numbered. TO BE COMPLETED BY THE APPLICANT I. PERSONAL INFORMATION (1) Enter the name of the applicant. (2) Enter the case number for which representation is being provided. (3) Enter the date of birth of the applicant. Use the format Month/Day/Year. (4) Enter the street address where the applicant receives mail. Include P.O. Box number, street number, and apartment number where applicable, as well as the city, state, and zip code. (5) Enter the home telephone number of the applicant. If there is no home telephone, write “none” in this space. (6) Enter the residential address of the applicant if it is different from the mailing address. If the mailing address and the residential address are the same, leave this space blank. (7) Enter the number of a telephone where the applicant may receive messages within 48 hours after the caller leaves them. This is especially important if there is no home telephone. There must be a way for the courts and the appointed attorney(s) to contact the applicant by telephone if necessary. II. OTHER PERSONS LIVING IN HOUSEHOLD (8) Enter the names of other persons living in the applicant’s household. These other persons may include children and other dependents as well as other financially contributing members of the household. (9) Enter the ages of the other persons living in the applicant’s household. (10) Enter the relationship to the applicant of the other persons living in the household. For example, to indicate the relationship of a female child of the applicant, this space should read “daughter,” not “father” or “mother.” If there are more than four other persons living in the applicant’s household, attach an additional sheet that provides the same information for those not listed on the form. -43American LegalNet, Inc. www.USCourtForms.com APPENDIX E III. MONTHLY INCOME / EMPLOYMENT For each type of income, the applicant must enter their own earnings in the “Self” column, the spouse’s earnings in the “Spouse” column, and the total earnings of other financially contributing persons living in the household in the “Household Members” column. In the “Total” column, enter the total income from each type by adding the amounts across each row. List monthly income figures for the following: (11) Earnings or wages before taxes. (12) Unemployment compensation received. (13) Workers’ compensation received. (14) Pension benefits received. (15) Social security benefits received. (16) Child support received from a parent not living in the household. Do not include ADC in the calculation of this amount. (17) Works First/TANF. (18) Disability pay. (19) Any other income source. Note: Food stamps can no longer be considered as income. 51 USC 2107 (b). (20) Any other income source. (21) Enter the total income for the household by adding together the amounts in the “Total” column. (22) Enter the name of the applicant’s employer and the name(s) of the employer(s) of any other employed household member(s). (23) Enter the address and phone number of the employer(s). IV. ALLOWABLE MONTHLY EXPENSES List monthly household expenses for the following: (24) Child support actually paid for children not residing in the applicant’s household. (25) Child care. This expense may not be claimed if any adult member of the applicant’s household is unemployed. -44American LegalNet, Inc. www.USCourtForms.com APPENDIX E (26) Transportation to and from work. This may include bus fare or gasoline and parking expenses, but not auto insurance or repairs. (27) All types of insurance. This should include medical, dental, life, homeowners insurance, renters insurance, automobile insurance, etc. (28) Health and dental care that is over and above the amount paid for medical and dental insurance. This may include prescription medications, co-payments, the payment of deductibles, etc. (29) Medical expenses and other expenses incurred in caring for sick or injured family members. (30) Enter the total of monthly expenses by adding together the entries in the “Amount” column. V. TOTAL INCOME (31) Enter the amount shown at “Subtotal A,” the space identified in these instructions as number (20). (32) Enter the amount shown at “Subtotal B,” the space identified in these instructions as number (30). (33) Enter the total monthly income at “Grand Total C” by subtracting the amount in space (32) from the amount in space (31). VI. ASSET INFORMATION For each “Type of Asset” listed in this section, the applicant must describe the item(s) in the center column including length of ownership and the make, model, and year of the asset whenever applicable, and indicate the value of that item in the “Estimated Value” column. The following instructions clarify the types of assets about which information is requested. (34) “Real Estate/Home” includes any and all property and buildings owned or mortgaged by the applicant. The description of the property or buildings should include the length of ownership. The estimated current market value of the property or buildings should be entered in the “Estimated Value” column. (35) List the total of all “Stocks/Bonds/CD’s” owned by the applicant. (36) “Automobiles” includes cars only. (37) “Trucks/Boats/Motorcycles” includes any type of mechanically powered vehicle other than cars used for transportation. (38) Other Valuable Property may include precious metals and/or stones, works of art, valuable collections, electronic equipment, farm equipment, etc. This category does not include home furnishings and clothing. -45American LegalNet, Inc. www.USCourtForms.com APPENDIX E (39) “Cash on Hand” includes any U.S. currency immediately available to the applicant. (40) “Money owed to applicant” includes tax refunds, anticipated dividends, or any accounts payable expected from an individual or an organization for which agreed upon services or goods were provided by the applicant for an agreed upon price. (41) “Other” refers to any other type of asset owned by the applicant to which a dollar value can be attached. (42) Enter the name of the bank at which the checking account is held, the account number, and the current balance of the checking account. (43) Enter the name of the bank at which the savings account is held, the account number, and the current balance of the savings account. (44) Enter the name of the credit union at which an account is held, the account number, and the current balance of the account. (45) Enter the “Grand Total” of the applicant’s assets by adding together the amounts entered in the “Estimated Value” column. VII. MONTHLY LIABILITIES / OTHER EXPENSES The applicant must enter the monthly amount of each “Type of Liability” listed in this section. The following instructions clarify the liabilities about which information is requested. (46) “Rent/Mortgage” refers to any payment made for living quarters. The total amount paid must be entered in this space. (47) “Food” refers to the amount spent on food by the applicant’s household. The dollar value of food purchased with food stamps should be included in the amount entered. (48) “Electric” refers to the cost of electricity purchased from a regulated electricity provider. If the cost of electricity is included in the monthly rent, no dollar amount should be entered here. (49) “Gas” refers to the cost of natural gas or L.P. gas purchased from a regulated natural gas or L.P. gas provider. If this cost is included in the monthly rent, no dollar amount should be entered here. (50) “Fuel” refers to the cost of gasoline purchased for purposes other than transportation to and from work, plus the amount of other fuels purchased for other necessary reasons such as heating and the operation of farm machinery. (51) “Telephone” refers to the cost of all local and long distance telephone calls. (52) “Cable” refers to the cost of cable television service. -46American LegalNet, Inc. www.USCourtForms.com APPENDIX E (53) “Water/Sewer/Trash” refers to the cost of each of these services. If the applicant is not billed directly for one or more of these services, no dollar amount should be entered here. (54) “Credit Cards” refers to the total of the minimum monthly payments currently owed on all major credit cards, department store cards, or independent credit cards held by the applicant. (55) “Loans” refers to the total monthly payments on all loans including student loans, automobile loans, and loans for other purposes. Home mortgages are not to be included in this category. (56) “Taxes Owed” refers to the monthly amount of federal, state, and local taxes owed by the applicant. These include current taxes withheld by the employer as well as past tax debt that is currently being repaid. (57) “Other” refers to any other regular monthly expenditure (e.g. education for children or self, rent-to-own items, etc.). (58) Enter the “Grand Total E” by adding together all the liabilities and other expenses in the section. VIII. GRAND TOTALS (59) Enter the “Total Monthly Income.” This is the same number found at “Grand Total C,” or number (33) of these instructions. (59) Enter the “Total Assets.” This is the same number found at “Grand Total D,” or number (45) of these instructions. (61) Enter the “Total Monthly Liabilities/Other Expenses.” This is the same amount found at “Grand Total E,” or number (61) of these instructions. IX. AFFIDAVIT OF INDIGENCY (62) Print or type the name of the applicant. (63) Enter the signature of the applicant and the date of signature as witnessed by a notary public. TO BE COMPLETED BY A NOTARY PUBLIC (64-65) Enter the date the signing of the affidavit was witnessed. (66) Enter the county in which the signing of the affidavit was witnessed. (67) Enter the state in which the signing of the affidavit was witnessed. -47American LegalNet, Inc. www.USCourtForms.com APPENDIX E (68) The notary public must sign and stamp the form. TO BE COMPLETED BY THE JUDGE X. JUDGE CERTIFICATION This section of the form should only be completed if the applicant is unable to fill out the financial disclosure form and/or sign the affidavit of indigency. In such a case, the judge may indicate by his or her signature that the applicant is indeed indigent. (69) List the reason the client is unable to sign the form. (70) The judge must sign any form that cannot be properly completed by the applicant. -48American LegalNet, Inc. www.USCourtForms.com FINANCIAL DISCLOSURE/AFFIDAVIT OF INDIGENCY I. PERSONAL INFORMATION Case No. Name Mailing Address City (4) Residence (if different from above) Name 1) (8) D.O.B. (2) (1) (4) Age (9) 2) (3) State (4) ZIP Phone (4) ( ) (5) Message Phone (within 48 hours) ( ) (7) (6) II. OTHER PERSONS LIVING IN HOUSEHOLD Relationship Name (10) 3) Age Relationship 4) III. MONTHLY INCOME/EMPLOYMENT INFORMATION Self Spouse Household Members (11) Type of Income Employment (Gross) Unemployment (12) Worker’s Comp. (13) Pension (14) Social Security (15) Child Support (16) Works First/TANF (17) Disability (18) Other (19) Other Total (20) Employer’s Name (for all household members) (22) Address (23) IV. ALLOWABLE EXPENSES Type of Expense Amount (24) Child Support Paid Out (25) Child Care (if working only) Transportation for Work (28) Medical & Associated Costs Of Caring for Infirm Family Members (29) (21) (23) V. TOTAL INCOME Total Monthly Income – Total Allowable Expenses = Total Income (27) Medical/Dental $ Phone ( ) (26) Insurance SUBTOTAL A - SUBTOTAL A SUBTOTAL B $ (31) $ (32) GRAND TOTAL C $ (33) SUBTOTAL B $ Type of Asset Real Estate / Home VI. ASSET INFORMATION Describe / Length of Ownership / Make, Model, Year (where applicable) Price:$ Date Purchased: (34) Equity: (30) Stocks / Bonds / CD’s (35) Automobiles (36) Trucks / Boats / Motorcycles (37) Other Valuable Property (38) Cash on Hand (39) Money Owed to Applicant (40) Other (41) Checking Acct. (Bank / Acct. #) (42) Savings Acct. (Bank / Acct. #) (43) Credit Union (Name / Acct. #) Estimated Value (44) GRAND TOTAL D $ (45) American LegalNet, Inc. www.USCourtForms.com VII. MONTHLY LIABILITIES/OTHER EXPENSES Type of Liability VIII. GRAND TOTALS Amount Grand Total C Rent / Mortgage (46) Food (47) Electric (48) Gas (49) Fuel (50) Telephone (51) Cable (52) Water / Sewer / Trash (53) Credit Cards (54) Loans (55) Taxes Owed (56) Total Monthly Liabilities Other (57) and Other Expenses GRAND TOTAL E Total Monthly Income (59) Grand Total D Total Assets (60) Grand Total E (61) (58) IX. AFFIDAVIT OF INDIGENCY I, ______________________________(62)_________________________________ being duly sworn, say: 1. I am financially unable to retain private counsel without substantial hardship to me or my family. 2. I understand that I must inform my attorney if my financial situation should change before the disposition of my case. 3. I understand that if it is determined by the county, or by the Court, that legal representation was provided to for me to which I was not entitled, I may be required to reimburse the county for the costs of representation provided. Any action filed by the county to collect legal fees hereunder must be brought within two years form the last date legal representation was provided. 4. I understand that I am subject to criminal charges for providing false financial information in connection with the above application for legal representation pursuant to Ohio Revised Code Sections 120.05 and 2921.13. 5. I hereby certify that the information I have provided on this financial disclosure form is true to the best of my knowledge. (63) Client’s Signature Date Notary Public: Subscribed and duly sworn before me according to law, by the above named applicant this _(64)_ day of ______(65)_____________, _______, County of _________(66)______________ and State of ______(67)_______. (68) Notary’s Signature X. JUDGE CERTIFICATION I hereby certify that above-noted client is unable to fill out and/or sign this financial disclosure/ affidavit for the following reason: __________________________(69)_____________________________________. I have determined that the applicant meets the criteria for receiving court appointed counsel. (70) Judge’s Signature OPD-206R (12/97) Date American LegalNet, Inc. www.USCourtForms.com APPENDIX F Instructions for Completing Monthly Operating Expenses and Caseload Report for County Public Defender Offices Form OPD-E-501 The following instructions are for the Monthly Operating Expenses and Caseload Report for County Public Defender Offices form (OPD-E-501). For the purpose of these instructions, the form is divided into five sections, A - E, and spaces requiring an entry have been numbered. These instructions also apply to Joint County Public Defender Offices and non-profit organizations with which counties have contracted to serve as the County Public Defender Office. TO BE COMPLETED BY THE COUNTY AUDITOR Section A (1) Enter the name of the county served by the public defender office. (2) Enter the month and year for which reimbursement is requested on this form. For each type of expenditure indicated in spaces numbered (3) through (18), please enter expenditures for only the month and year indicated at number (2). (3) Enter total expenditures for salaries for employees. (4) Enter total expenditures for employee benefits for employees including PERS or other retirement benefits. (5) Enter total expenditures for supplies. (6) Enter total expenditures for the purchase or non-contractual repair of equipment. (7) Enter total expenditures for contract services such as experts, investigation, and temporary help. (8) Enter total expenditures for office space and facilities. (9) Enter total expenditures for repair and maintenance contracts for equipment. (10) Enter total expenditures for travel costs. (11) Enter approved monthly cost allocation. (12) Enter any other expenses not included in the above categories. Please attach a separate sheet detailing these expenses. (13) Enter the subtotal of expenses listed in spaces (3) through (13). (14) Enter total expenditures for transcripts. -51American LegalNet, Inc. www.USCourtForms.com APPENDIX F (15) Enter the amount of federal funds expended during the month. This figure represents the amount of total expenditures listed in (13) above that were from federal funds. Federal funds are those which were received in either the current or a prior month, but which were expended in the current month. This adjustment to “total cost” is required pursuant to R.C. 120.18(A). (16) Enter the amount of non-governmental funds from other sources expended during the month. This figure represents the amount of total expenditures listed in (13) above which were either non-federal grants or gifts. This adjustment to “total cost” is required pursuant to R.C. 120.18(A). Note: This does not include funds collected from clients. A portion of all funds collected from clients under reimbursement, recoupment, contribution, or partial payment programs must be paid directly to the Ohio Public Defender. See Section (G) of the Ohio Public Defender County Public Defender Office Reimbursement Standards. (17) Enter the grand total of allowable expenditures. Add space (13) to space (14) and subtract spaces (15) and (16) from the sum. Section B (1) Enter the date the form is submitted to the Office of the Ohio Public Defender. (2) Enter the name of the county served by the public defender office. (3) Enter the number of the county served by the public defender office. (4) The county auditor must sign the form in this space. Section C Spaces (22) and (23) are to be completed by the Office of the Ohio Public Defender only. The rate of reimbursement employed for the month indicated in space (2) shall be entered in space (22) and the total amount to be reimbursed to the county shall be entered in space (23). TO BE COMPLETED BY THE COUNTY PUBLIC DEFENDER Section D (24) Enter the name of the county being served by the public defender office. (25) Enter the month and year corresponding to the caseloads listed on the form. For each type of case in spaces (26) through (63) please enter the caseloads for the month indicated at number (25) only. (26) Enter the number of felony trial cases closed. (27) Enter the number of felony pleas or plea bargain cases closed. -52American LegalNet, Inc. www.USCourtForms.com APPENDIX F (28) Enter the number of felony cases dismissed. (29) Enter the number of other dispositions for felony cases closed. (30) Enter the total number of felony cases closed. (31) Enter the number of felony cases pending at the end of the month. (32) Enter the number of misdemeanor trial cases closed. (33) Enter the number of misdemeanor pleas or plea bargain cases closed. (34) Enter the number of misdemeanor cases dismissed. (35) Enter the number of other dispositions for misdemeanor cases closed. (36) Enter the total number of misdemeanor cases closed. (37) Enter the number of misdemeanor cases pending at the end of the month. (38) Enter the number of juvenile delinquency and/or unruliness cases closed. (39) Enter the number of juvenile custody, dependency, neglect or abuse cases closed. (40) Enter the number of juvenile parentage cases closed. (41) Enter the number of juvenile non-support contempt cases closed. (42) Enter the number of other juvenile cases closed. (43) Enter the total number of juvenile cases closed. (44) Enter the number of juvenile cases pending at the end of the month. (45) Enter the number of parentage cases closed in domestic relations court. (46) Enter the number of non-support contempt cases closed in domestic relations court. (47) Enter the number of other cases closed in domestic relations court. (48) Enter the total number of cases closed in domestic relations court. (49) Enter the number of cases pending in domestic relations court at the end of the month. (50) Enter the number of appeals closed. (51) Enter the number of appeals pending at the end of the month. (52) Enter the number of post conviction motions filed. -53American LegalNet, Inc. www.USCourtForms.com APPENDIX F (53) Enter the number of post conviction motions pending. (54) Enter the number of parole and probation revocations represented. (55) Enter the number of parole and probation revocations pending. (56) Enter the number of Habeas Corpus cases closed. (57) Enter the number of Habeas Corpus cases pending at the end of the month. (58) Enter the number of Extradition cases closed. (59) Enter the number of Extradition cases pending at the end of the month. (60) Enter the number of other cases closed. (61) Enter the number of other cases pending at the end of the month. (62) Enter the total number of cases closed. Add spaces (30), (36), (43), (48), (50), (52), (53), (54) (56), and (58) to find the sum. (63) Enter the total number of cases pending at the end of the month. Add spaces (31), (37), (44), (49), (51), (55), (57), (59), and (61) to find the sum. (64) Enter the number of felonies filed in Municipal Court. Report only cases which continued on to Common Pleas Court. If a felony case is filed and plead as a misdemeanor in Municipal Court, count the case as a felony plea in item 27 above. (65) Enter the number of cases in which the client was found to be not indigent, those clients for which the office handled the arraignment only, and those cases that were referred to appointed counsel due to a conflict of interest. Section E (66) Enter the name of the County Public Defender or designee. (67) The County Public Defender or his or her designee must sign the form. (68) Enter the date the form was signed by the County Public Defender. -54American LegalNet, Inc. www.USCourtForms.com Monthly Operating Expenses and Caseload Report for County Public Defender Office OPD-E-501 (Revised 1/96) Section A Operating Expenses Report for: County______(1)_____ Month____(2)____ Year__(2)__ OBJECT CLASSIFICATION EXPENSES Salaries: ...............................................................……….............. ________(3)_______ Fringes: ..........................................................................……….... ________(4)_______ 6-G-3 Supplies: ......................................................................………...... ________(5)_______ 6-G-4 Equipment: .............................................................………............ ________(6)_______ 6-G-5 Contract Services: ..................................................………............ ________(7)________ 6-G-6 Rental & Facilities: .................................................………............ ________(8)_______ 6-G-7 Contract Repairs: ..............................................………................. ________(9)_______ 6-G-8 Travel: ...................................................................………............. ________(10)______ 6-G-9 Cost Allocation: ........................................................……….......... ________(11)______ 6-G-10 Other Expenses (Please Specify): ............................……….......... ________(12)______ SUB TOTAL........................…...... ________(13)______ Transcripts: ......................................................………................... ________(14)______ Less Federal Funds Expended: ................................………......... (________(15)_____) Less Other Funds Expended: ............................................……….. (________(16)_____) GRAND TOTAL............................. _________(17)_____ 6-G-2 Section B The County Auditor in executing this certification attests to the accuracy of the figures contained herein and further certifies that the County Commissioners have approved this sum for payment. A subsequent audit by the Ohio Public Defender Commission and/or the Auditor of State which reveals unallowable or excessive costs may result in future adjustment against reimbursement or repayment of audit exceptions to the Ohio Public Defender Commission. Date Submitted: ______________(18)_________________________ _________(19)_____________ County _____(20)______ County Number _________________ (21)_________________ County Auditor Section C To be completed by the Office of the Ohio Public Defender: Percent of Reimbursement: .................................... ________(22)______ Amount Reimbursed to County: .............................. ________(23)______ American LegalNet, Inc. www.USCourtForms.com Section D Caseload Report for: County_________(24)__________ Month______(25)_____ Year___(25)__ CLOSED PENDING Felonies: Trials: ......................................…….........................… ____(26)____ Pleas or Plea Bargains: ................……...................... ____(27)____ Dismissals: .........................................……................. ____(28)____ Other Dispositions: ...................................…….......... ____(29)____ Total Felonies: ..................................……..... ____(30)____ Misdemeanors: Trials: ...............................................................……... ____(32)____ Pleas or Plea Bargains: ....................................…….. ____(33)____ Dismissals: .......................................................……... ____(34)____ Other Dispositions: ..........................................……... ____(35)____ Total Misdemeanors: .........................……... ____(36)____ Juvenile Proceedings: Delinquency and Unruliness: ...............……............... ____(38)____ Custody, Dependency, Neglect, and Abuse:…........... ____(39)____ Parentage: ......................................................…….... ____(40)____ Non-Support Contempt: ...................................…….. ____(41)____ Other Juvenile: ................................................……... ____(42)____ Total Juvenile: ....................................……... ____(43)____ Domestic Relations: Parentage: .......................................................……... ____(45)____ Non-Support Contempt: ........................……............. ____(46)____ Other: ..........................................................……....... ____(47)____ Total Domestic Relations: ..................…….. ____(48)____ ____(49)____ Appeals: .............................................................….......... ____(50)____ ____(51)____ Postconviction Motions: ....................................…....... ____(52)____ ____(53)____ Parole and Probation Revocations: ......................….... ____(54)____ ____(55)____ Habeas Corpus: ......................................................….... ____(56)____ ____(57)____ Extraditions: .............................................................…... ____(58)____ ____(59)____ Miscellaneous: ........................................................….... ____(60)____ ____(61)____ TOTAL CASES............…………....................…... ____(62)____ ____(63)____ Felonies filed in Municipal Court:.................…... ____(64)____ Not indigent, arraignment only, or conflicts: .... ____(65)____ Section E ____(31)____ ____(37)____ ____(44)____ CERTIFICATION I ______________(66)___________________ hereby certify that all persons provided representation by this office during the month covered by this report were indigent under the standards of the Ohio Public Defender Commission, Ohio Revised Code Section 120.15(D). Signature: __________(67)__________________________ Date: _________(68)________________ American LegalNet, Inc. www.USCourtForms.com