FORM AF-1 (Rev. 2004) CLAIM FOR ATTORNEY FEES (APPELLATE/TRIAL) INSTRUCTIONS: Type and submit in duplicate to the appropriate clerk of court. Please complete the form in full. If an order is required, it must be stapled to the back of your claim form. Incomplete claim forms will be returned. Both copies must be signed by the attorney and judge. For trial court claims, the clerk shall retain one copy for the court files and shall forward the original to the Administrative Office of the Courts, Attorney Claims, Nashville City Center, Suite 600, 511 Union, Nashville, TN 37219. For appellate claims, the appellate court clerk shall retain one copy for its files and shall forward the original to the appropriate Appellate Court Judge. STATE OF TENNESSEE COUNTY OF: __________________________ Court __________________________ (specify court) Court of Criminal Appeals Supreme Court Court of Appeals NAME OF CLIENT: _____________________________________________________ Trial Court No.: ___________________________________ Appeal No.: __________________________________________ 1. ____________________________________________ in violation of TCA Section _____________________________ Original Offense 2. Type of case: _____ Felony _____ Misdemeanor _____ Post Conviction _____ First Degree Murder _____ Petition for Early Release _____ Probation Violation _____ Lead _________________ Class _____ Juvenile _____ Contempt ____ Other: _____________ _____ Yes _____ No _____ Co-Counsel Did the DA file a notice of intent to seek the death penalty? If notice was withdrawn give date ______________________________________ 3. Conviction offense___________________________________________ 4. Date of disposition_________________________ Date of last activity in relation to the case____________________________ 5. Disposition of case: _____ Plea of guilty _____ Nolle prosequi SUMMARY OF ACTIVITY TOTALS (From itemized list on back of form) _____ Trial by jury (A) IN-COURT HOURS (Tenths) Sentence received_____________________________ _____ Trial by judge _____ Other (B) OUT-OF-COURT HOURS (Tenths) _____ Cert. question (C) NECESSARY EXPENSES TOTALS Enter FULL Name, Address and Phone Number Here (Please supply full address and phone number.) I certify that the foregoing represents an accurate, complete statement of time and expenses in connection with the above action or proceedings. Attorney: ____________________________________________ Address: ____________________________________________ ___________________________________________________ Signature of Attorney _____________________________________________________ City: ______________________ State: _____ Zip ___________ Soc. Sec. No.: ______________________________________ Phone: ______________________________________________ TO BE COMPLETED BY JUDGE (A) ________ Total Approved In-Court Hours @ $50 Per Hour................................................. (In capital cases, lead counsel @ $100 Per Hour; co-counsel @ $80 Per Hour) (In capital post - conviction cases @ $80 Per Hour) (B) ________ Total Approved Out-of-Court Hours @ $40 Per Hour.......................................... (In capital cases, lead counsel @ $75 Per Hour; co-counsel @ $60 Per Hour) (In capital post - conviction cases @ $60 Per Hour) (C) Total Approved Necessary Expenses ..................................................................................... TOTALS.................... Subject to the provisions of T.C.A. ' 40-14-207, the Court finds this to be reasonable compensation for work done in the above-style case/appeal. This the _____ day of __________________, ______. _________________________________________________________ Signature of Judge __________________________________________________________ Judge’s Name — Please Print American LegalNet, Inc. www.USCourtForms.com ACTIVITY DATE Itemize in-court and out-of court hours spent working on this case. Itemize any out-of-pocket expense. Itemize any other approved expenses & attach to this claim a certified copy of the court=s prior approval of such expense. (A) IN-COURT HOURS (Tenths) (B) OUT-OF COURT HOURS (Tenths) (C) NECESSARY EXPENSES TOTALS: American LegalNet, Inc. www.USCourtForms.com