State of Alabama  
Unified Judicial System 

FORM - FIS - 45        Rev.12/07
Name of Administrator  

EXPENSE CLAIM 
FOR SERVICES 

Title of Administrator  

County  

Circuit  

AOC USE ONLY 

PAYROLL NUMBER 

STATE W/H 

I  hereby  request  compensation  from  the  Fiscal  Officer,  Administrative  Office  of  Courts,  for  services 
rendered as follows:  

FEDERAL W/H 

 Special Court Reporter   
 
 

(cid:134) Part-time Referee  
 

 

 

 
 
 

 
 
 

(cid:134) On-Call Warrant Clerk  
(cid:134) Other (specify) ______________________ 
     __________________________________ 

DATE APPROVED  

 NOTE: Expense Claims for Services by Temporary Aides should be submitted on Form PERS-39.  
MUST ENTER REFERENCE NUMBER AND DATE OF ADC APPROVAL, AUTHORITY  

APPROVED BY 

Failure to enter reference number will delay the processing of the expense claim for services)  
FEES AND EXPENSES  

ees for ______ days at $ _________ per day if paid at daily rate …………………………………  $ ____________ 
Fees for ______ hours at $ ________ per hour if paid at hourly rate  ……………………………… $ ____________ 
Per diem for overnight travel expenses ______ days at $ ___________per day……………………. $ ____________ 
* Mileage ___________miles at $ ____________ per mile………………………………………….$ ____________ 

 

 

 

 

     TOTAL EXPENSES CLAIMED………………….$ ____________ 

 Mileage is paid based on state mileage chart/map.  
Actual Dates Worked:  
 

Month ______________________ Date ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
Month ______________________ Date ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
Month ______________________ Date ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

Make Warrant Payable To:  
 

ERTIFICATION:  

Name:     ____________________________________________________ 
SSN:       _____________________________________________________ 
Address:  ____________________________________________________ 
____________________________________________________________ 

  hereby  certify  that  the  above  is  a  true  and  correct  statement  of  compensation  due  for  the  period  of  __________________ 
through ________________________________________________, and is in accordance with applicable legal statutes. 

________________________________________________ 
SIGNATURE OF ADMINISTRATOR  

DATE  

 

  

  (cid:134)

  *

      (

  F

   

  *

  C

  I

     

    R

ETURN TO:  

FINANCE DIVISION 
ADMINISTRATIVE OFFICE OF COURTS 
300 DEXTER AVENUE  
MONTGOMERY, AL 36104