W.Va. Crime Victims Compensation Fund 1900 Kanawha Blvd., E., Rm. W-334 Charleston, WV 25305-0610 Page 1 Attorney Fee Voucher Attorney ____________________________Claimant: _________________________ Claim No. CV-____________ The following services were rendered to this claimant in connection with the claim cited above. Legal Services ITEMIZED TIME MUST BE IN TENTHS OF AN HOUR. Date Hours IN Court Hours OUT of Court Brief explanation of activity (time and research) Total time IN court ___________ hours x $65.00 = $________________ Total time OUT of court __________ hours x $45.00 = + Total Legal Services $ (enter this amount on page 2) z:\cvcf\cvclaims\atty fee voucher.FSL (09/16/08) American LegalNet, Inc. www.FormsWorkflow.com Page 2 Reimbursable Expenses The following services were rendered to this claimant in connection with Claim No. CV-______________. Date Type of Expense (telephone, travel, postage, expert witness, and court reporter) Notes or Comments Cost Total Expenses $____________ Summary Total Legal Services (from page 1) - - - - - - - - - - - - - - - - - - $ ____________________ Total Reimbursable Expenses (from page 2) - - - - - - - - - - - + Total Claim $ I hereby certify that the statements contained herein are true and correct. Complete here for Individual Complete here for Corporation or Partnership Payee's Signature Payee's Signature Payee's Name (please print or type) OR Payee's Name (please print or type) Mailing Address Mailing Address City State Corp. Zip Partnership City State Zip FEIN: __________________________________________ SSN: __________________________________________ E-mail (please print clearly) E-mail (please print clearly) Note: State warrant for attorney fees will be issued in name(s) as completed above. "An attorney shall not contract for or receive any larger sum than the amount allowed under this section." W.Va. Code §14-2A-19. American LegalNet, Inc. www.FormsWorkflow.com