EXPERT WITNESS CLAIM FOR COMPENSATION Pursuant to 22 O.S. 1985 '' 463 and 1176, court-appointed expert witnesses may be compensated from the State Judicial Fund for services rendered. Please complete this form and return it to the Administrative Office of the Courts, 1915 N. Stiles, Suite 305, Oklahoma City, OK 73105. CLAIMANT: TAX I.D. OR SOCIAL SECURITY NUMBER: DEFENDANT'S FULL NAME: CASE NUMER: CASE STYLE: FILED IN: COUNTY. TRIED IN: COUNTY OFFENSE: NATURE OF WITNESS' SERVICES: NUMBER OF HOURS SPENT: In Court Out-of-Court TOTAL HOURS Reasonable hourly fee within the community COMPENSATION MUST BE APPROVED BY THE JUDGE AWARDING THE CLAIMANT'S FEE. Compensation is approved as follows: Prior to and in preparation of Preliminary Hearing $ At Preliminary Hearing $ From Bind Over Order until final trial disposition $ TOTAL APPROVED COMPENSATION $ If multiple expert witnesses were approved for this defendant, indicate: Name of Witness Compensation Awarded I, the undersigned, do sate that I have full knowledge of the foregoing claim and that the services listed have been rendered. Claimant Date APPROVED: Judge Title Chief Justice Date APPROVED: PLEASE ATTACH THE FOLLOWING DOCUMENTS: 1) A certified copy of Court Order Authorizing Witness. 2) A certified copy of Application to Award Witness Fees. 3) Itemized Statement of Witness. 4) Sole Source Payment Affidavit of Witness. 5) Certified copy of Court Order Awarding Witness Fees. 6) Certified copy of Court Order authorizing multiple expert witnesses, if applicable. F:\staff\form\aocform.06/Revised 3/14/91 2000 © American LegalNet, Inc. STATE OF OKLAHOMA ) ) SS COUNTY ) AFFIDAVIT OF CLAIMANT FOR EXPERT WITNESS FEES , of lawful age, first being duly sworn, deposes and says: As authorized by Order of the Honorable , District/Associate District/Special Judge, of County, entered on the day of , 199 , I provided professional services to the defendant in a case styled and numbered as State of Oklahoma v. , in which said defendant was charged with the crime of . Further, that the amount to be awarded by the trial court will/will not be the sole source of compensation for the services provided to the above-mentioned defendant. Other sources and amounts of compensation for said services are set forth below: Source: Amount: CLAIMANT Subscribed and sworn to before me this , 199 . day of Notary Public My Commission Expires: F:\Staff\Forms\AOCFORM.06 Revised 3/14/91 2000 © American LegalNet, Inc.