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ATTORNEY’S FEE DECLARATION
(Juvenile) 
[For Appointments made prior to 6/14/2011] 

Unified Judicial System 
orm AFD-3    Rev.12/2011 

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tate of Alabama 

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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.)  

n court Appearance (Trial Level or Post-Conviction Proceeding)  
Out-of-Court Preparation (Trial Level or Post-Conviction Proceeding)  
Preparation (Appellate Level)    
Extraordinary Expenses (If approved in advance by the Court)                                                                                                          ___________________ 
Overhead Expenses (If approved in advance by the Court) 

     Total Hours __________ x   $ 60.00  per hour  = ___________________ 
     Total Hours __________ x   $ 40.00  per hour  = ___________________ 
Total Hours __________ x   $ 60.00  per hour  = ___________________ 

                       Total Hours _________ x  $ _______ per hour =   ___________________     

                     

  

 

 

NOTICE TO ATTORNEY: Complete this form. Attach a copy of a complete itemization of in-court appearances; out-of-court preparation; preparation for 
appeals; extraordinary expenses; and/or overhead expenses reflecting the date of actions and amount of time involved in each activity. 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.   
 
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) and that if 
serving as a child’s attorney or GAL, I have performed the duties required under Alabama law. 

 

 

 

 

 

 

 

 

 

 

    TOTAL CLAIM OF ATTORNEY                       ______________________ 

 

 

________________________________________________________                             ________________________________________________ 
                                                   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 foregoing claim has been presented to me, and I have reviewed the same and believe the same to be 
true and correct.  I am further of the opinion that said attorney is not duplicating said charges and expenses in any case (companion or otherwise).  

ased on the above, I hereby approve the attorney’s declaration and claim in the amount of $_____________________. 

_________________________________________________________________               ____________________________________ 
 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  (including  petition  for  writ  of  certiorari  to  the  Alabama 
Supreme Court), and in post-conviction proceedings.  

HIS  FORM  MUST  CONTAIN  ORIGINAL  SIGNATURES  OF  THE  ATTORNEY  AND  THE  JUDGE.  THIS  FORM  WITH  ATTACHED  ITEMIZATION  MUST  BE 
SUBMITTED TO THE TRIAL COURT JUDGE OR PRESIDING JUDGE OR CHIEF JUSTICE OF THE APPELLATE COURT FOR CERTIFICATION, FILED WITH 
THE CLERK, AND THEN SUBMITTED TO THE OFFICE OF INDIGENT DEFENSE SERVICES.  

iled in the Clerk’s Office at _______________________________, Alabama, on __________________________. 

 

 

 

 

 

 

 

          Date 

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

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