INTERPRETER INVOICE SNOHOMISH COUNTY COURTS District Court: Everett Evergreen South Cascade Superior Court: Courthouse Denney Other Interpreter Name/Agency Name: _______________________________ Language: _________________ Date of Service: _________ Address: ______________________________________ Phone: __________________________ FAX: ______________________ Washington Court Certified Yes No Washington Court Registered Yes No In-Court Qualified Yes Session AM PM No This invoice must be signed by a court clerk/official and submitted to the court on the day of service. All information must be supplied no later than forty-five (45) days following the service or this invoice will not be paid. Location Requesting Job # Case Hearing Time Total Clerk's Signature (Division/ Began Ended Party Number Type Court) Claimant Certification: I hereby certify that under penalty of perjury that this is a true and correct claim for interpreter services provided by me on behalf of the Court and no payment have been received by me on account thereof. Signature: _______________________________________ Printed Name: _____________________________ Date: _____________ Travel Documentation: See back for form Purposes of this Form include facilitating the court's eligibility under the Washington State Administrative Office of the Courts (AOC) Interpreter Services Funding Program by: 1. Compiling data required by the AOC for interpreter services reimbursement. 2. Establishing pay rates that are in conformance with the AOC Payment Structure. The standard certified rate the court intends to pay from May 1, 2015 forward is $50/hour with a two hour minimum. All other details regarding payment are covered in our "Interpreter Policy and Procedures" document. (http://www.snohomishcountywa.gov/575/Interpreter-Services or http://www.snohomishcountywa.gov/1436/Interpreter-Services) STAFF USE ONLY: County job #: AOC #: Amount to pay: hours + mileage=total Approved by: American LegalNet, Inc. www.FormsWorkFlow.com Revised: 4/6/2015 Travel Payment Defined: Interpreters will be paid mileage from the address of origin1 to the appointment/job location. Mileage will be paid at the prevailing state rate. Travel is only paid from point of origin to appointment/job except when the interpreter's next address of destination is a Snohomish County District Court or Superior Court location. In those instances, mileage will be paid between appointments/jobs. Roundtrip2 travel will not be paid. i. A MapQuest is required with all invoices where travel is claimed. Failure to provide this will result in payment for services only. ii. If the interpreter's subsequent job is within walking distance, travel will not be paid. TRAVEL REIMBURSEMENT: Original Address: _________________________________________________________________________________ Court Destination: Secondary Court Destination: _________________________________________________________________________________ _________________________________________________________________________________ MILEAGE TRAVEL TOTAL BILLED MapQuest Mileage Readout attached Yes No COMMENTS:________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 1 2 Address of origin means the interpreter's home, office or immediately previous appointment location within Snohomish County. Roundtrip means from the interpreter's home/office to the appointed appointment/job, followed by the interpreter's return to their home/office. Revised: 4/6/2015 American LegalNet, Inc. www.FormsWorkFlow.com