CJA 20 APPOINTMENT OF AND AUTHORITY TO PAY COURT APPOINTED COUNSEL (Rev. 5/99)
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 Name:
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 name appears in Item 12 is appointed to represent this person in this case, OR
14. 3.	NAME AND MAILING ADDRESS OF LAW FIRM (Only provide per instructions)
□	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
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
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
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:
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 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 approved	DATE	34a. JUDGE CODE
in excess of the statutory threshold amount.