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Handbook for Official Court Reporters - Kansas Judicial Branch

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COURT REPORTER CLAIM FORM<br />

FEIN/SSN 0 Elec Deposit Mail original dalm <strong>for</strong>m WITH invoic.e and order to:<br />

DBNBusiness<br />

Name<br />

Mailing Address<br />

Board of Indigents' Defense Services<br />

71 4 SW Jackson St, Ste 200<br />

Topeka, KS 66603-3722<br />

Phone: (785) 296-663 1 Fax: (785) 291-3082<br />

Payee No.<br />

City State Zip<br />

E-Mail<br />

Phone<br />

Fax<br />

BIDS use only<br />

Service Code<br />

LocCode<br />

Current Case In<strong>for</strong>mation<br />

O Check this box if there have been any changes to the In<strong>for</strong>mation<br />

0 Civil 1507 I Habeas Corpus<br />

above since you r last claim was submitted.<br />

District <strong>Court</strong> Appellate<br />

0 Criminal /Traffic Felony<br />

Case No. Case No. 0 PV I Probation Viola ton<br />

BIDS Use Only 0 Direct Appeal<br />

Name of Indigent Person<br />

AKA<br />

Name of Attorney Requesting Services<br />

County<br />

A. COURT REPORTERS: COPY OF THE ORDER FOR TRANSCRIPT MUST BE STAPLED BEHIND ALL OTHER DOCUMENTS.<br />

Originals pages @ $3.50 I page =<br />

so.oo<br />

(Effective 1112/12)<br />

Originals pages @ $3.25 I page = so.oo (Through 12/31111 )<br />

ONLY MULTIPLE DEFENDANT CASES:<br />

Duplicates pages@ $0.50 I page = $0.00<br />

Please list no. (1-1 4 as specified on revised order) of requested hearings that have been completed <strong>for</strong> this claim:<br />

GRAND TOTAL AMOUNT OF CLAIM<br />

Grand Total<br />

SO.OO<br />

I hereby certify the above charges to be just, correct,<br />

unpaid, and due by law.<br />

Reviewed and Approved.<br />

BIDS Use Only<br />

Original Signature of CSR Date Origin I Signature of District <strong>Court</strong> Judge<br />

Date<br />

Audited/ Approved<br />

RETAIN 1 COPY FOR YOUR RECORDS - NO COPY WIU BE RETURNED.<br />

AIMsed 12/28111<br />

<strong>Handbook</strong> <strong>for</strong> <strong>Official</strong> <strong>Court</strong> <strong>Reporters</strong><br />

Page 34

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