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 _____________
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