CJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT-APPOINTED COUNSEL (Rev. 07/17)

1. CIR./DIST./ DIV. CODE 2. PERSON REPRESENTED VOUCHER NUMBER

3. MAG. DKT./DEF. NUMBER 4. DIST. DKT./DEF. NUMBER 5. APPEALS DKT./DEF. NUMBER 6. OTHER DKT. NUMBER

7. IN CASE/MATTER OF (Case Name) 8. PAYMENT CATEGORY 9. TYPE PERSON REPRESENTED 10. REPRESENTATION TYPE

Felony Petty Offense Adult Defendant Appellant (See Instructions)

Misdemeanor Other Juvenile Defendant Appellee

Appeal Other

11. OFFENSE(S) CHARGED (Cite U.S. Code, Title & Section) If more than one offense, list (up to five) major offenses charged, according to severity of offense.

12. ATTORNEY’S NAME (First Name, M.I., Last Name, including any suffix), 13. COURT ORDER

AND MAILING ADDRESS O Appointing Counsel C Co-Counsel

F Subs For Federal Defender R Subs For Retained Attorney

P Subs For Panel Attorney Y Standby Counsel

Prior Attorney’s

 Appointment Dates:

Because the above-named person represented has testified under oath or has otherwise 

Telephone Number : satisfied this Court that he or she (1) is financially unable to employ counsel and (2) does

not wish to waive counsel, and because the interests of justice so require, the attorney whose

14. NAME AND MAILING ADDRESS OF LAW FIRM (Only provide per instructions) name appears in Item 12 is appointed to represent this person in this case, OR

Other (See Instructions)

Signature of Presiding Judge or By Order of the Court

Date of Order Nunc Pro Tunc Date

Repayment or partial repayment ordered from the person represented for this service at time

appointment. YES NO

 CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY

CATEGORIES (Attach itemization of services with dates) HOURS

CLAIMED

TOTAL

AMOUNT

CLAIMED

MATH/TECH.

ADJUSTED

HOURS

MATH/TECH.

ADJUSTED

AMOUNT

ADDITIONAL

REVIEW

15. a. Arraignment and/or Plea In Court

b. Bail and Detention Hearings

c. Motion Hearings

d. Trial

e. Sentencing Hearings

f. Revocation Hearings

g. Appeals Court

h. Other (Specify on additional sheets)

(RATE PER HOUR = $ ) TOTALS:

16. a. Interviews and Conferences Out of Courtb. Obtaining and reviewing records

c. Legal research and brief writing

d. Travel time

e. Investigative and other work (Specify on additional sheets)

(RATE PER HOUR = $ ) TOTALS:

17. Travel Expenses (lodging, parking, meals, mileage, etc.)

18. Other Expenses (other than expert, transcripts, etc.)

GRAND TOTALS (CLAIMED AND ADJUSTED):

19. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE 20. APPOINTMENT TERMINATION DATE 

 IF OTHER THAN CASE COMPLETION

21. CASE DISPOSITION

FROM: TO:

22. CLAIM STATUS Final Payment Interim Payment Number Supplemental Payment

Have you previously applied to the court for compensation and/or reimbursement for this case? YES NO If yes, were you paid? YES NO

Other than from the Court, have you, or to your knowledge has anyone else, received payment (compensation or anything of value) from any other source in connection with this 

representation? YES NO If yes, give details on additional sheets. 

I swear or affirm the truth or correctness of the above statements.

Signature of Attorney Date

APPROVED FOR PAYMENT — COURT USE ONLY

23. IN COURT COMP. 24. OUT OF COURT COMP. 25. TRAVEL EXPENSES 26. OTHER EXPENSES 27. TOTAL AMT. APPR./CERT.

28. SIGNATURE OF THE PRESIDING JUDGE DATE 28a. JUDGE CODE

29. IN COURT COMP. 30. OUT OF COURT COMP. 31. TRAVEL EXPENSES 32. OTHER EXPENSES 33. TOTAL AMT. APPROVED

34. SIGNATURE OF CHIEF JUDGE, COURT OF APPEALS (OR DELEGATE) Payment approved DATE 34a. JUDGE CODE

in excess of the statutory threshold amount.

Case 3:22-cr-00052-S Document 25 Filed 06/15/22 Page 1 of 1 PageID 48