FORM 13.   Invoice of Counsel for Indigent Party

                       (Rule 15.4(c))

                                   No. (appellate court)

     (SUPREME COURT or COURT OF APPEALS, DIVISION  ___)
                 OF THE STATE OF WASHINGTON

(Title of trial court proceeding )
with parties designated as in    )        INVOICE OF COUNSEL
rule 3.4)                        )        FOR INDIGENT PARTY

    (Name of claimant counsel) submits this invoice to be paid from public
funds. An order authorizing the expenses claimed by this invoice was
entered in (name of court) on (date of entry). ("A copy of the order is
attached." or "The order of indigency is located at CP page ____.") My
Social Security number (or, my firm's IRS employer identification number)
is ____.
    1. I claim $______ for attorney fees. I spent ______ hours on the
review and a reasonable hourly charge is $______. I performed the following
services:
    (List services; for example: "Reviewed record, prepared brief of
appellant and reply brief of appellant, oral argument in Court of Appeals,
and prepared cost bill.")
    2. The following expenses were incurred for the review:
    (List each item of expense including preparing reproducible originals
at the rate per page set pursuant to rule 14.3(b), the amount, and the
total of all items listed.)
    3. I have not filed another invoice in this cause.
    4. The total amount of this invoice is (the totals from paragraphs 1
and 2) $______.
    I swear or affirm that the items listed are correct charges for
necessary services rendered and expenses incurred for proper consideration
of the review and I have not been promised compensation for the review from
the indigent party or from any other source except as has been approved by
the court.

                                 _____________________________________
                                             Signature
                                 (Name, address, telephone number, and
                                 Washington State Bar Association
                                 membership number of claimant)

SUBSCRIBED AND SWORN to before me this ____ day of ____________, 19__.
                                 _____________________________________
                                 Notary Public in and for the State of
                                 Washington, residing at _____________