1

INSTRUCTIONS

This form is designed to serve as both the voucher for fees in appellate assigned cases and the case summary attorneys are
required to submit to the Michigan Appellate Assigned Counsel System under section 4(6)(c)(ii) of the regulations governing
that system. The form should be completed as follows:

1. The attorney, upon completing all work within the scope of the order of appointment (whether that order was for representation
in the Court of Appeals or the Supreme Court), should fill out all applicable lines of section I. Apart from basic background
 
 
information, section I primarily seeks information about the case not readily available from such other sources as appellate
  court docket entries.

2. The attorney should fill out the fee and expense information in section II completely, then sign and date the declaration. The
  attorney should leave sections III and IV blank.

3. The attorney should then provide the entire form, with all copies intact, to the trial judge who signed the order of appointment.
  Counsel may wish to photocopy the form before filing it in case the original is lost.

4. The assigning judge should review the case summary, indicate in section III the fees and expenses actually being approved,
  and sign and date the form.

5. The court should keep the white copy, return the pink copy to the attorney, and forward the yellow copy to:

                          
                           
                           
                     
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

  Michigan Appellate Assigned Counsel System
  200 N. Washington Square
  Suite 250
  Lansing, MI 48913

1. Attorney name

2. Bar no.

3. Telephone no.

I. CASE INFORMATION

4. Address

5. Case name

9. Date appointed 10. County

11. Judge

12. Case   

 Plea    

 Bench

13. Transcript length (all

   transcripts)                      pp.

 Prob. viol.
14.                                              OFFENSE(S)  Include MCL cite                                                                      SENTENCES

      Type:   

 Jury    

6. Lower court no.

7. Court of Appeals no.

8. Supreme Court no.

15. Client            Date

Location

Client no.

16. Trial court motion/type:              Date  Result

18. Date of motion to withdraw as counsel 19. Resentencing/Evidentiary      Date

Result

If held, date and location

21. Disposition:            Date Result

      hearing:

      Visit:
17. Date of stipulation to dismiss

20. Court of Appeals oral argument:
 Held

 Not held 

      

 

CC 400 

(6/19)

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          MAACS STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF COURT APPOINTED COUNSEL,                         Page Approved, SCAO Original - Court (white)1st copy - MAACS (yellow)2nd copy - Attorney (pink)STATE OF MICHIGANJUDICIAL CIRCUITCOUNTY MAACS STATEMENT OF SERVICE ANDORDER FOR PAYMENT OF COURTAPPOINTED COUNSEL (Page    )CASE NO.Court addressCourt telephone no.2

II.  FEE INFORMATION
      SERVICES RENDERED    Itemize on additional sheet if needed

 

ACTUAL EXPENSES

HOURS

 

 miles x 
 miles x 

 ¢/mile $
21. Client visit     
 
 ¢/mile $
22. Oral argument 
 
23. Photocopying   
 ¢/page $
 
24. Postage............................................ $
25. Phone calls...................................... $
26. Other (itemize)................................... $
27. TOTAL EXPENSES: $

 
 pages x 
 

        REQUEST FOR PAYMENT

28. Fee requested................................. $
29. Expenses requested........................ $

30. TOTAL AMOUNT REQUESTED $

        BASIS OF REQUEST

 Fee schedule
 Hourly

31. 
32. 
 
 
35. 

  33. Rate/hour.................................. $
  34. Maximum allowed (if applicable) $

 Motion for extraordinary fees (attach copy)

I declare that I was appointed by the court to serve as 
appellate counsel for the named defendant, and that
above is a true statement of uncompensated services
rendered and expenses incurred by me in the conduct of
that appeal to the best of my information, knowledge, and
belief.

*e.g. correspondence, filing claim, procuring records and transcripts,
housekeeping motions, transmitting records to client or substitute counsel.

III. ORDER FOR PAYMENT

Date

Attorney signature

I certify that the above attorney was appointed to represent the named defendant, and the service was rendered.

IT IS ORDERED the City/County of 

 

 pay the above attorney $ 

 in fees and

 

 in expenses, for a total of $ 
 

 in compensation for all time and expense in connection with this case.

 

 

Judge                                                                                            Bar no.

  1.  Record review
 
 (transcript, court file, PSR/SIR)..........
  2.  Client visit (including travel)...............
  3.  Other client contact............................
 Trial court motions (prepare, appear):
 
 new trial..........................
 4. 
 
 
 withdraw plea..................
 5. 
 
 
 resentencing...................
 6. 
 
 
  7. Evidentiary hearing
 
 (prepare, appear)..............................
  8.  Resentencing (prepare, appear)........
  9.  COA leave application.......................
10.  COA motion to remand......................
11.  COA brief on appeal (research, write)
12. COA oral argument
 
 (prepare, appear, travel).....................
13.  COA motion for rehearing...................
14.  Reply to prosecutor’s S Ct appl.........
15.  S Ct leave application.........................
16.  S Ct brief on leave granted.................
17.  S Ct oral argument.............................
18.  Administrative* 
 
 
  
19.  Other 
 
 

 

 
  

20. TOTAL HOURS:

$ 
 

Date

IV. COURT USE ONLY

CC 401 

(12/88)

 

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          MAACS STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF COURT APPOINTED COUNSEL,                         Page Approved, SCAO Original - Court (white)1st copy - MAACS (yellow)2nd copy - Attorney (pink)STATE OF MICHIGANJUDICIAL CIRCUITCOUNTY MAACS STATEMENT OF SERVICE ANDORDER FOR PAYMENT OF COURTAPPOINTED COUNSEL (Page    )CASE NO.Court addressCourt telephone no.