CJA 30 DEATH PENALTY PROCEEDINGS: 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. TYPE PERSON REPRESENTED	9. REPRESENTATION TYPE
□	Adult Defendant	□	Appellant	□	Other	□ Z	D1 28 U.S.C. § 2254 Habeas (Capital)	□	D3 28 U.S.C. § 2255 (Capital)
□	Habeas Petitioner	□	Appellee	□	D2 Federal Capital Prosecution	□	D4 Other (Specify)
10. 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.
11.	ATTORNEY'S NAME (First Name, M.I., Last Name,	12. COURT ORDER:
including any suffix), AND MAILING ADDRESS	□	O Appointing Counsel	□	C Co-Counsel
□	F Subs For Federal Defender	□	R Subs For Retained Attorney
□	P Subs For Panel	□	Y Standby Counsel
Prior Attorney's Name:	Appointment Date:
(A) 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 (2) does not wish to waive counsel, and because the interests of justice so require, the attorney whose name appears in Item 11, who has been determined to possess the specific qualifications by law, is appointed to represent the person in this case.
(B) The attorney named in Item 11 is appointed to serve as:	□	LEAD COUNSEL	□	CO-COUNSEL
Telephone Number:
Name of Co-Counsel
13.	NAME AND MAILING ADDRESS OF LAW FIRM	:	Appointment Date:
(Only provide per instructions)	(C) If you represented the defendant or petitioner in any prior proceeding related to this matter, attach to your initial claim a listing of those proceedings and describe your role in each (e.g., lead in counsel or co-counsel).
□	(D) Due to the expected length of this case, and the anticipated hardship on counsel in undertaking representation full-
time, for such a period without compensation, interim payments of compensation and expenses are approved pursuant to
the attached order.
Signature of Presiding Judicial Officer or By Order of the Court
Date of Order	Nunc Pro Tunc Date
(E) Repayment or partial repayment ordered from the person represented for this service at time of appointment.
□	YES	□	NO
CLAIM FOR SERVICES AND EXPENSES
14. STAGE OF PROCEEDING	Check the box which corresponds to the stage of the proceeding during which the work claimed at Item 15 was performed even if the work is intended to be used in connection with a later stage of the proceeding. CHECK NO MORE THAN ONE BOX. Submit a separate voucher for each stage of the proceeding.
CAPITAL PROSECUTION	HABEAS CORPUS	OTHER PROCEEDING
a.	□	Pre-Trial	e.	□	Appeal	g.	□	Habeas Petition	k.	□	Petition for the	l.	□	Stay of Execution	o.	□	Other
b.	□	Trial	f.	□	Petition for the	h.	□	Evidentiary Hearing	U.S. Supreme Court	m.	□	Appeal of Denial of Stay
c.	□	Sentencing	U.S. Supreme Court	i.	□	Dispositive Motions	Writ of Certiorari	n.	□	Petition for Writ of Certiorari to the U.S.
d.	□	Other Post Trial	Writ of Certiorari	j.	□	Appeal	Supreme Court Regarding Denial of Stay
HOURS AND COMPENSATION CLAIMED	FOR COURT USE ONLY
15.	CATEGORIES (Attach itemization of services with dates)	HOURS

CLAIMED	TOTAL

AMOUNT

CLAIMED	MATH/TECH.

ADJUSTED

HOURS	MATH/TECH.

ADJUSTED

AMOUNT	ADDITIONAL

REVIEW
a. In-Court Hearings (RATE PER HOUR = $	)	IN COURT

TOTAL

Category a	IN COURT

TOTAL

Category a
b. Interviews and Conferences with Client
c. Witness Interviews
d. Consultation with Investigators & Experts
e. Obtaining & Reviewing the Court Record
f. Obtaining & Reviewing Documents and Evidence	OUT OF COURT

TOTAL

Categories b-j	OUT OF COURT

TOTAL

Categories b-j
g. Consulting with Expert Counsel
h. Legal Research and Writing
i. Travel
j. Other (Specify on additional sheets)
TOTALS: Categories b thru j (RATE PER HOUR = $	)
CLAIM FOR TRAVEL AND EXPENSES (Attach itemization of expenses with dates)
16.	Travel Expenses (lodging, parking, meals, mileage, etc.)
17.	Other Expenses (other than expert, transcripts, etc.)
GRAND TOTALS (CLAIMED AND ADJUSTED):
18. CERTIFICATION OF ATTORNEY/PAYEE FOR THE PERIOD OF SERVICE	19. APPOINTMENT TERMINATION DATE

IF OTHER THAN CASE COMPLETION	20. CASE DISPOSITION
FROM:	TO:
21. 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
22. IN COURT COMP.	23. OUT OF COURT COMP.	24. TRAVEL EXPENSES	25. OTHER EXPENSES	26. TOTAL AMT. APPROVED
27. SIGNATURE OF THE PRESIDING JUDICIAL OFFICER	DATE	27a. JUDGE CODE