CJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT APPOINTED COUNSEL

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

(See Instructions)

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

X

Prior Attorney's Name:

Appointment Date:

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

otherwise satisfied this court that he or she (1) is financially unable to employ counsel and

Telephone Number: (2) does not wish to waive counsel, and because the interests of justice so require, the

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

Other (See Instructions)

Signature of Presiding Judicial Officer 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 of appointment. YES NO

CLAIM FOR SERVICES AND EXPENSES FOR COURT USE ONLY

TOTAL MATH/TECH MATH/TECH HOURS ADDITIONAL CATEGORIES (Attach itemization of services with dates) AMOUNT ADJUSTED ADJUSTED CLAIMED REVIEW CLAIMED HOURS AMOUNT

15. a. Arraignment and/or Plea

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:

I

n

C

o

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t

16. a. Interviews and Conferences

b. 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:

O

u

t

o

f

C

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t

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 21. CASE DISPOSITION IF OTHER THAN CASE COMPLETION FROM TO

22. CLAIM STATUS Final Payment Interim Payment Number Supplemental Payment

Have you previously applied to the court for compensation and/or remimbursement 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 or 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 JUDICIAL OFFICER DATE 28a. JUDGE / MAG. 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 DATE 34a. JUDGE CODE

approved in excess of the statutory threshold amount.

COX DALTON, MARIE

1:11-002106-001

US v. 927 Cole Street, Go Other Other: Civil Asset Forfeiture

GOODREID, THOMAS E.

1801 Broadway, Suite 1100

Denver CO 80202

(303) 292-0110

01/11/2012

Case No. 1:11-cv-02106-PAB-CBS Document 35 filed 01/11/12 USDC Colorado pg 1 of 1