AOC USE ONLY 

pproved By _____________________ 

ate ___________________________ 

und _____________ Prog._________ 

rg. _____________ Object _________ 

Total Amount of Claim  

$ ______________ 

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State of Alabama  
Unified Judicial System  
Form FIS 23      Rev. 12/07 

JUROR EXPENSE CLAIM 
Meals, Lodging, Etc. 

ounty ________________________ Circuit ___________________ 
Case Number(s) __________________________________________ 
Style of Case(s) __________________________________________ 
_______________________________________________________ 
Prepared by _________________________ Date _______________ 
Telephone ______________________________________________ 

 

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INSTRUCTIONS  

1.  Please complete one expense claim per vendor.  
2.  Attach all required statements and itemized invoices, signed by accompanying court attendant, bailiff, or 

3.  Meals are provided for sequestered jurors only and a court attendant, bailiff, or deputy sheriff.  

deputy sheriff.  

(Section 12-16-10, Alabama Code 1975) 

4.  Overnight lodging provided for sequestered jurors and a court attendant, bailiff, or deputy sheriff.  

Lodging allowance: Should be obtained at a reasonable local rate with two jurors per room.  
One local telephone call per juror can be included in the lodging bill.  

5.  Claims for interpreter services for jurors require an accompanying court order appointing the interpreter.  

Rates for foreign language services:$20.00 p/hour in-court translation & mileage at the current state rate.  
Rates for hearing impaired services: Require certification documentation and should be obtained at a reasonably  
accepted rate set by certifying organization.  

ITEMIZED EXPENSES  

Meals & Lodging for Sequestered Jurors and court attendant, bailiff, or deputy sheriff (Attach applicable invoices).  
         ________# Meals (tax exempt) for a total of  
 
 
 
         ________# Persons lodged (include lodging tax) for a total of  
Interpreter Services for Jurors (Attach applicable court orders & invoices.) 
         ___ Foreign Language: _______# of hours in-court @$25 p/hour    
          $ _______________ 
 
 
    _______# of miles @ current state rate  
          $ _______________ 
          $ _______________ 
           
         ___ Hearing Impaired: (Certification required as set out in #5 above.)  
Other Expenses as Specified _________________________________________          $ _______________ 
_________________________________________________________________ 

          $ _______________ 
          $ _______________ 

 

 

 

 

 

 

 

TOTAL CLAIM  

 

 

          $ _______________

ake Warrant Payable to:     ________________________________________________________ 
    Vendor’s Name  
          /Business Telephone Number 
    ________________________________________________________ 
    Vendor’s Business Address 
    ________________________________________________________ 
    Vendor’s Federal Tax Identification Number  

 

   

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      ____________________________________ 
       Judge/Clerk  

   

CERTIFICATION  
      I  herby  certify,  as  a  circuit  court  judge/clerk,  that  the  above  is  a  true  and  correct  statement  of  expenses 
incurred  during  the  period  of  ______________________  through  ___________________,  20  ____,  and  is  in 
accordance with applicable legal statutes and orders of the court.  
     Done this the _________ day of ________________________, 20 ___.  

Note: Examiners of Public Accounts will contact the official expense claim regarding audit questions.  

 
PLEASE COMPLETE FULLY AND ATTACH ALL REQUIRED DOCUMENTATION AND APPLICABLE COURT ORDERS. 

Return to: Administrative Office of Courts 
Finance Division/Expense Accounting Section 
300 Dexter Avenue  
Montgomery, AL 36104-3741 

   RETAIN A COPY FOR YOUR RECORDS