Case Number 

_ _    _ _ _ _   _ _ _ _ _   _ _ 
Jurisdiction     Year     Case#          Suffix  

   

 

County 
Code 
__  __ 

 

ATTORNEY’S FEE DECLARATION
(Juvenile) 
[For Appointments made on or after 6/14/2011] 

Unified Judicial System 
orm AFD-4      Rev.12/2011 

  F

tate of Alabama 

    S

         

n the Juvenile Court of:  
__________________________ County                                                  
                                                                                                                     ______________________________________________   
 
                                                                                                                     ______________________________________________ 
                                                                                                                       Social Security Number or FEIN 

                              Attorney Name (Please type or print)  

                                                                     

 

 

ppeal To:                                                            Type of Case: 
□ Alabama Court of Criminal Appeals                  □ Delinquency  
□ Alabama Court of Civil Appeals                         □ Dependency 
□ Supreme Court of Alabama                               □ Child In Need of Supervision (CHINS) 
                                                                                                  □ Other (describe) _____________________________________ 
                                                                                                   
 

The undersigned attorney declares that on (date) ____________________________, the Honorable ___________________________________ 
_______________________, Judge, appointed the undersigned to represent  □Child; □Mother; □Father; □ as GAL for Child; □ as GAL for Other 
_______________________;  □legal custodian / legal guardian; □ petitioner;  □ Other __________________________________________and on 
(date)___________________________, the case was disposed of by ______________________________________________________________ 

______________________________________________________________________________________________________________________. 

 

   

             (Adjudication of dependency, in need of supervision or delinquency, cert. denied, etc.)  

     Total Hours __________ x   $ 70.00  per hour  = ___________________ 
n court Appearance (Trial Level or Post-Conviction Proceeding)  
     Total Hours __________ x   $ 70.00  per hour  = ___________________ 
Out-of-Court Preparation (Trial Level or Post-Conviction Proceeding)  
                       Total Hours __________ x   $ 70.00  per hour  = ___________________ 
Preparation (Appellate Level)    
Reimbursable Non-overhead Expenses up to $300 (Receipts attached)                                                                                
 ___________________ 
Reimbursable Non-overhead Expenses exceeding $300 (Pre-approved by the Court and Receipts attached)                                 ___________________ 
   

 

 

    TOTAL CLAIM OF ATTORNEY                       ______________________

 

OTICE TO ATTORNEY: Complete this form. Attach a copy of a complete itemization of in-court appearances; out-of-court preparation; preparation for 
appeals; and all reimbursable non-overhead expenses. Attach original invoice or receipt for all expenses and corresponding court orders.  Make a copy 
of  same  for  the  court’s  record  and  a  copy  or  your  records.    This  form  and  attachments  must  be  received  by  the  Office  of  Indigent  Defense 
Services no later than 90 days from final disposition of the case. 
 
The undersigned attorney further declares that the above claim is true and correct and represents the services actually rendered by him/her as an attorney and the 
amount  is  due  and  payable.  I  further  declare  that  the  above  claim  is  not  a  duplication  of  charges  and  expenses  in  any  case  (companion  or  otherwise).  

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

________________________________________________________                             ________________________________________________ 
                                                   Date 
Signature of Attorney  

 

 

Attorney Code ____________________________________________                              
                                                                                                                                            
Mailing Address of Attorney 
(please type or print) (including city, state, and zip code)  

_________________________________________________________________ 

________________________________________________________________ 

________________________________________________________________ 

-mail Address:_____________________________________  Telephone Number ____________________ Fax Number ______________________ 

,  the  undersigned  judge,  hereby  certify  that  the  attorney  presenting  this  claim  provided  representation  in  this  matter  and  that  said  matter  has  been 
concluded.  I am further of the opinion that this claim is reasonable based upon the defense provided.    

_________________________________________________________________                              ________________________________________ 
 Judge’s Signature                                                                                                                                   Date 

OTICE TO ATTORNEY AND JUDGE: Sections 15-12-21 through 15-12-23, Ala. Code 1975, provide for the payment of attorney fees and extraordinary 

expenses incurred by counsel appointed to represent indigent defendants at the trial level, on appeal, and in post-conviction proceedings.  

RIAL COURTS – WHEN THE FEE DECLARATION ONLY SEEKS REIMBURSMENT FOR NON-OVERHEAD EXPENSES EXCEEDING $300, THE 

JUDGE’S SIGNATURE IS NOT REQUIRED.  SEND FEE DECLARATION DIRECTLY TO OFFICE OF INDIGENT DEFENSE SERVICES.   

PPELLATE COURTS – WHEN THE FEE DECLARATION SEEKS REIMBURSMENT FOR APPELLATE SERVICES, THE APPELLATE JUDGE’S 

OR JUSTICE’S SIGNATURE IS NOT REQUIRED.  SEND FEE DECLARATION DIRECTLY TO OFFICE OF INDIGENT DEFENSE SERVICES.   

HIS  FORM  MUST  CONTAIN  ORIGINAL  SIGNATURES  OF  THE  ATTORNEY  AND  THE  JUDGE  (WHEN  REQUIRED).  THIS  FORM  WITH  ATTACHED 
ITEMIZATION  MUST  BE  SUBMITTED  TO  THE  TRIAL  COURT  JUDGE  FOR  CERTIFICATION,  AND  THEN  SUBMITTED  TO  THE  OFFICE  OF  INDIGENT 
DEFENSE SERVICES.  
 

  MAIL TO: Office of Indigent Defense Services, P.O. BOX 302598, Montgomery, Alabama 36130-2598. 

  I

  A

  _

 

  I

  N

  _

  _

    E

  I

   

  N

  T

  A

  T