ATTORNEY FEE VOUCHER GALVESTON COUNTY Disposition Date: ___/___/____ District Court #__________________ Cause #/Offense_____________________________________________ Trial – Jury Hired New Counsel County Court at Law #____________ Cause #/Offense_____________________________________________ Trial – Court Atty. Withdrawn Cause #/Offense_____________________________________________ Plea Atty. Removed Cause#/Offense______________________________________________ Dismissed No-Billed Cause#/Offense______________________________________________ Dism/Red to Misd. #________________ STYLE: State of Texas v. ___________________________________________________________________________ Offense Level: Felony Misdemeanor Juvenile Appeal Capital – Death Penalty Capital – Non-Death MRP – Felony MRP-Misdemeanor Attorney (Full Name:______________________________________________________ Telephone #__________________________ SS#:________________________ Street Address: _______________________________________________________ Fax #_______________________________ BAR#_______________________ City/State/Zip _______________________________________________________ TAX ID#____________________ Time Period for Services Rendered: Beginning ___/___/____ through ___/___/____ Flat Fee – Court Appointed Services Jail Docket week $900.00 $ In Court Services: Brief Description Hours Dates Rate Total (Includes Plea, Dismissal, No-Billed, etc. in accorandance _____________________________________________________________________________________________________________ with adopted fee schedule and rate of $60.00 per hour) _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Out of Court Services: Brief Description Hours Dates Rate Total _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Total from Additional Pages: Other Allowable Expenses: ____________ Brief Description _______________ __________________________ Cost Date Total _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Investigator: SUBMIT BILL FROM INVESTIGATOR To be paid by: County Attorney $__________________ Expert Witness: SUBMIT BILL FROM EXPERT/DOCTOR/OTHER To be paid by: County Attorney $__________________ Pysc. Evaluation: SUBMIT BILL FROM DOCTOR To be paid by: County Attorney $__________________ Monies Received from Defendant or on behalf of Defendant: (MINUS) $__________________ Final Payment Partial Payment (allowed in special cases only, with Judge’s approval) TOTAL COMPENSATION AND EXPENSES CLAIMED(do not include amounts to investigators, experts, etc. to be paid by County) $__________________ ATTORNEY CERTIFICATION I, the undersigned attorney, certify that the above information is true and correct and in accordance with the laws of the State of Texas. The compensation and expensees claimed were reasonable and necessary to provide effective assistance counsel. I further certify that I am/was licensed by the State of Texas, during the time period these services were rendered to practice as an attorney in the State of Texas. Attorney Signature:_________________________________________________________ Date:______/______/_______ Signature of Presiding Judge:________________________________________________________________ Date:_____/______/________ $___________________ TOTAL ALLOWED REASON FOR DENIAL OR VARIATION:_____________________________________________________________________________________FORM GC#8 American LegalNet, Inc. www.FormsWorkFlow.com