REQUEST FOR PAYMENT FOR QUALIFIED INTERPRETER STATE OF SOUTH CAROLINA COUNTY OF _________________________ ) ) ) ) ) ) ) ) ) ) ) IN THE COURT OF ________________________ JUDICIAL CIRCUIT No. CASE NO. _________________________ _________________________ Plaintiff vs. _________________________ Defendant Pursuant to S.C. CODE ANN. Sections 15-27-15, 15-27-155, or 17-1-50, claim is hereby made for compensation of the services of a qualified interpreter who has been approved by the Court. Note: Interpreters will receive an hourly rate for services rendered in one day (not per case), with a two-hour minimum. If interpreting services exceed one day, the hourly rate per hour will be paid for actual time of services rendered (to the nearest quarter-hour). Hours at $ per hour / Miles from City County To City / County TOTAL $ at $0.535 = $ $ Mileage may be reimbursed at the official state rate when assignment is outside residence county or place of business. I hereby certify that this is a true and correct statement of my mileage and services rendered for interpreting the court proceeding to a deaf or non-English speaking person who is a juror or a party to the proceeding or a witness therein. Signature of Interpreter I am (check one): S.C. State Employee Printed Name of Interpreter Privately Employed (State employees attest by their signature that they did not perform these services as part of their normal duties or on State time.) CHECK WILL BE MADE PAYABLE AND MAILED TOTHE INDIVIDUAL OR FIRM LISTED BELOW. SOCIAL SECURITY OR F.E.I. NUMBER MUST BE INCLUDED. IF A W-9 IS NOT ON FILE, PLEASE ENCLOSE. NAME: _________________________ APPROVED BY: Presiding Judge ADDRESS: _________________________ _________________________ TELEPHONE NO. _________________________ S. S. # or F. E. I. #: _________________________ _________________________ Printed Name of Judge Date: _________________________ SCCA/263 (1/2017) NOTE: Original form or Certified True Copy only. Forms not in compliance will be returned. American LegalNet, Inc. www.FormsWorkFlow.com