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Motion, Entry, and Certification for Appointed Counsel Fees – Ohio Courts
Page 1 – Motion for Approval, Summary of Charges, Billing, and Judgment Entry
Court Type (e.g., Common Pleas)
County Name
Plaintiff Name
Case Number
Appellate Case Number (if applicable)
Capital Offense Case
Defendant / Party Represented
Guardian Ad Litem
In Re (subject matter)
Judge Name
Periodic Billing
Date Appointed (Month/Day)
Year Appointed
Termination Date (Month/Day)
Termination Year
Submission Date (Month/Day)
Submission Year
Attorney Name (Printed)
Attorney Signature
Street Address
City
State
ZIP Code
OSC Reg. No.
Offense/Charge/Matter 1
ORC/City Code 1
Degree 1
Disposition 1
Offense/Charge/Matter 2
ORC/City Code 2
Degree 2
Disposition 2
Offense/Charge/Matter 3
ORC/City Code 3
Degree 3
Disposition 3
Out-of-Court Total Hours
Pre-Trial Hearing Hours
Hearings Hours
All Other In-Court Hours
In-Court Total Hours
Grand Total Hours
Flat Fee
Flat Fee Hours In-Court
Rate (In-Court per hour)
Fee Amount In-Court
Total Fees
Minimum Fee
Min Fee Hours Out-of-Court
Rate (Out-of-Court per hour)
Fee Amount Out-of-Court
Total Expenses
Grand Total (Fees + Expenses)
County Name (Judgment Entry)
Approved Amount
Extraordinary Fees Granted
Judge Signature
Judgment Date
County Number
Warrant Number
Warrant Date
County Auditor
Page 2 – Itemized Fee Statement and Expense Log
Case Number (Page 2)
Attorney / GAL Name
Co-Counsel Name (Capital Offense Cases Only)
Row 1 Left – Date of Service
Row 1 Left – Out-of-Court Hours
Row 1 Left – Pre-Trial Hours
Row 1 Left – Hearings Hours
Row 1 Left – All Other In-Court Hours
Row 1 Left – In-Court Daily Total
Row 1 Right – Date of Service (continued)
Row 1 Right – Out-of-Court Hours (continued)
Row 1 Right – Pre-Trial Hours (continued)
Row 1 Right – Hearings Hours (continued)
Row 1 Right – All Other In-Court Hours (continued)
Row 1 Right – In-Court Daily Total (continued)
Row 2 Left – Date of Service
Row 2 Left – Out-of-Court Hours
Row 2 Left – Pre-Trial Hours
Row 2 Left – Hearings Hours
Row 2 Left – All Other In-Court Hours
Row 2 Left – In-Court Daily Total
Row 2 Right – Date of Service (continued)
Row 2 Right – Out-of-Court Hours (continued)
Row 2 Right – Pre-Trial Hours (continued)
Row 2 Right – Hearings Hours (continued)
Row 2 Right – All Other In-Court Hours (continued)
Row 2 Right – In-Court Daily Total (continued)
Row 3 Left – Date of Service
Row 3 Left – Out-of-Court Hours
Row 3 Left – Pre-Trial Hours
Row 3 Left – Hearings Hours
Row 3 Left – All Other In-Court Hours
Row 3 Left – In-Court Daily Total
Row 3 Right – Date of Service (continued)
Row 3 Right – Out-of-Court Hours (continued)
Row 3 Right – Pre-Trial Hours (continued)
Row 3 Right – Hearings Hours (continued)
Row 3 Right – All Other In-Court Hours (continued)
Row 3 Right – In-Court Daily Total (continued)
Row 4 Left – Date of Service
Row 4 Left – Out-of-Court Hours
Row 4 Left – Pre-Trial Hours
Row 4 Left – Hearings Hours
Row 4 Left – All Other In-Court Hours
Row 4 Left – In-Court Daily Total
Row 4 Right – Date of Service (continued)
Row 4 Right – Out-of-Court Hours (continued)
Row 4 Right – Pre-Trial Hours (continued)
Row 4 Right – Hearings Hours (continued)
Row 4 Right – All Other In-Court Hours (continued)
Row 4 Right – In-Court Daily Total (continued)
Row 5 Left – Date of Service
Row 5 Left – Out-of-Court Hours
Row 5 Left – Pre-Trial Hours
Row 5 Left – Hearings Hours
Row 5 Left – All Other In-Court Hours
Row 5 Left – In-Court Daily Total
Row 5 Right – Date of Service (continued)
Row 5 Right – Out-of-Court Hours (continued)
Row 5 Right – Pre-Trial Hours (continued)
Row 5 Right – Hearings Hours (continued)
Row 5 Right – All Other In-Court Hours (continued)
Row 5 Right – In-Court Daily Total (continued)
Row 6 Left – Date of Service
Row 6 Left – Out-of-Court Hours
Row 6 Left – Pre-Trial Hours
Row 6 Left – Hearings Hours
Row 6 Left – All Other In-Court Hours
Row 6 Left – In-Court Daily Total
Row 6 Right – Date of Service (continued)
Row 6 Right – Out-of-Court Hours (continued)
Row 6 Right – Pre-Trial Hours (continued)
Row 6 Right – Hearings Hours (continued)
Row 6 Right – All Other In-Court Hours (continued)
Row 6 Right – In-Court Daily Total (continued)
Row 7 Left – Date of Service
Row 7 Left – Out-of-Court Hours
Row 7 Left – Pre-Trial Hours
Row 7 Left – Hearings Hours
Row 7 Left – All Other In-Court Hours
Row 7 Left – In-Court Daily Total
Row 7 Right – Date of Service (continued)
Row 7 Right – Out-of-Court Hours (continued)
Row 7 Right – Pre-Trial Hours (continued)
Row 7 Right – Hearings Hours (continued)
Row 7 Right – All Other In-Court Hours (continued)
Row 7 Right – In-Court Daily Total (continued)
Row 8 Left – Date of Service
Row 8 Left – Out-of-Court Hours
Row 8 Left – Pre-Trial Hours
Row 8 Left – Hearings Hours
Row 8 Left – All Other In-Court Hours
Row 8 Left – In-Court Daily Total
Row 8 Right – Date of Service (continued)
Row 8 Right – Out-of-Court Hours (continued)
Row 8 Right – Pre-Trial Hours (continued)
Row 8 Right – Hearings Hours (continued)
Row 8 Right – All Other In-Court Hours (continued)
Row 8 Right – In-Court Daily Total (continued)
Row 9 Left – Date of Service
Row 9 Left – Out-of-Court Hours
Row 9 Left – Pre-Trial Hours
Row 9 Left – Hearings Hours
Row 9 Left – All Other In-Court Hours
Row 9 Left – In-Court Daily Total
Row 9 Right – Date of Service (continued)
Row 9 Right – Out-of-Court Hours (continued)
Row 9 Right – Pre-Trial Hours (continued)
Row 9 Right – Hearings Hours (continued)
Row 9 Right – All Other In-Court Hours (continued)
Row 9 Right – In-Court Daily Total (continued)
Row 10 Left – Date of Service
Row 10 Left – Out-of-Court Hours
Row 10 Left – Pre-Trial Hours
Row 10 Left – Hearings Hours
Row 10 Left – All Other In-Court Hours
Row 10 Left – In-Court Daily Total
Row 10 Right – Date of Service (continued)
Row 10 Right – Out-of-Court Hours (continued)
Row 10 Right – Pre-Trial Hours (continued)
Row 10 Right – Hearings Hours (continued)
Row 10 Right – All Other In-Court Hours (continued)
Row 10 Right – In-Court Daily Total (continued)
Row 11 Left – Date of Service
Row 11 Left – Out-of-Court Hours
Row 11 Left – Pre-Trial Hours
Row 11 Left – Hearings Hours
Row 11 Left – All Other In-Court Hours
Row 11 Left – In-Court Daily Total
Row 11 Right – Date of Service (continued)
Row 11 Right – Out-of-Court Hours (continued)
Row 11 Right – Pre-Trial Hours (continued)
Row 11 Right – Hearings Hours (continued)
Row 11 Right – All Other In-Court Hours (continued)
Row 11 Right – In-Court Daily Total (continued)
Row 12 Left – Date of Service
Row 12 Left – Out-of-Court Hours
Row 12 Left – Pre-Trial Hours
Row 12 Left – Hearings Hours
Row 12 Left – All Other In-Court Hours
Row 12 Left – In-Court Daily Total
Row 12 Right – Date of Service (continued)
Row 12 Right – Out-of-Court Hours (continued)
Row 12 Right – Pre-Trial Hours (continued)
Row 12 Right – Hearings Hours (continued)
Row 12 Right – All Other In-Court Hours (continued)
Row 12 Right – In-Court Daily Total (continued)
Row 13 Left – Date of Service
Row 13 Left – Out-of-Court Hours
Row 13 Left – Pre-Trial Hours
Row 13 Left – Hearings Hours
Row 13 Left – All Other In-Court Hours
Row 13 Left – In-Court Daily Total
Row 13 Right – Date of Service (continued)
Row 13 Right – Out-of-Court Hours (continued)
Row 13 Right – Pre-Trial Hours (continued)
Row 13 Right – Hearings Hours (continued)
Row 13 Right – All Other In-Court Hours (continued)
Row 13 Right – In-Court Daily Total (continued)
Row 14 Left – Date of Service
Row 14 Left – Out-of-Court Hours
Row 14 Left – Pre-Trial Hours
Row 14 Left – Hearings Hours
Row 14 Left – All Other In-Court Hours
Row 14 Left – In-Court Daily Total
Row 14 Right – Date of Service (continued)
Row 14 Right – Out-of-Court Hours (continued)
Row 14 Right – Pre-Trial Hours (continued)
Row 14 Right – Hearings Hours (continued)
Row 14 Right – All Other In-Court Hours (continued)
Row 14 Right – In-Court Daily Total (continued)
Row 15 Left – Date of Service
Row 15 Left – Out-of-Court Hours
Row 15 Left – Pre-Trial Hours
Row 15 Left – Hearings Hours
Row 15 Left – All Other In-Court Hours
Row 15 Left – In-Court Daily Total
Row 15 Right – Date of Service (continued)
Row 15 Right – Out-of-Court Hours (continued)
Row 15 Right – Pre-Trial Hours (continued)
Row 15 Right – Hearings Hours (continued)
Row 15 Right – All Other In-Court Hours (continued)
Row 15 Right – In-Court Daily Total (continued)
Row 16 Left – Date of Service
Row 16 Left – Out-of-Court Hours
Row 16 Left – Pre-Trial Hours
Row 16 Left – Hearings Hours
Row 16 Left – All Other In-Court Hours
Row 16 Left – In-Court Daily Total
Row 16 Right – Date of Service (continued)
Row 16 Right – Out-of-Court Hours (continued)
Row 16 Right – Pre-Trial Hours (continued)
Row 16 Right – Hearings Hours (continued)
Row 16 Right – All Other In-Court Hours (continued)
Row 16 Right – In-Court Daily Total (continued)
Row 17 Left – Date of Service
Row 17 Left – Out-of-Court Hours
Row 17 Left – Pre-Trial Hours
Row 17 Left – Hearings Hours
Row 17 Left – All Other In-Court Hours
Row 17 Left – In-Court Daily Total
Row 17 Right – Date of Service (continued)
Row 17 Right – Out-of-Court Hours (continued)
Row 17 Right – Pre-Trial Hours (continued)
Row 17 Right – Hearings Hours (continued)
Row 17 Right – All Other In-Court Hours (continued)
Row 17 Right – In-Court Daily Total (continued)
Row 18 Left – Date of Service
Row 18 Left – Out-of-Court Hours
Row 18 Left – Pre-Trial Hours
Row 18 Left – Hearings Hours
Row 18 Left – All Other In-Court Hours
Row 18 Left – In-Court Daily Total
Row 18 Right – Date of Service (continued)
Row 18 Right – Out-of-Court Hours (continued)
Row 18 Right – Pre-Trial Hours (continued)
Row 18 Right – Hearings Hours (continued)
Row 18 Right – All Other In-Court Hours (continued)
Row 18 Right – In-Court Daily Total (continued)
Row 19 Left – Date of Service
Row 19 Left – Out-of-Court Hours
Row 19 Left – Pre-Trial Hours
Row 19 Left – Hearings Hours
Row 19 Left – All Other In-Court Hours
Row 19 Left – In-Court Daily Total
Row 19 Right – Date of Service (continued)
Row 19 Right – Out-of-Court Hours (continued)
Row 19 Right – Pre-Trial Hours (continued)
Row 19 Right – Hearings Hours (continued)
Row 19 Right – All Other In-Court Hours (continued)
Row 19 Right – In-Court Daily Total (continued)
Row 20 Left – Date of Service
Row 20 Left – Out-of-Court Hours
Row 20 Left – Pre-Trial Hours
Row 20 Left – Hearings Hours
Row 20 Left – All Other In-Court Hours
Row 20 Left – In-Court Daily Total
Row 20 Right – Date of Service (continued)
Row 20 Right – Out-of-Court Hours (continued)
Row 20 Right – Pre-Trial Hours (continued)
Row 20 Right – Hearings Hours (continued)
Row 20 Right – All Other In-Court Hours (continued)
Row 20 Right – In-Court Daily Total (continued)
Row 21 Left – Date of Service
Row 21 Left – Out-of-Court Hours
Row 21 Left – Pre-Trial Hours
Row 21 Left – Hearings Hours
Row 21 Left – All Other In-Court Hours
Row 21 Left – In-Court Daily Total
Row 21 Right – Date of Service (continued)
Row 21 Right – Out-of-Court Hours (continued)
Row 21 Right – Pre-Trial Hours (continued)
Row 21 Right – Hearings Hours (continued)
Row 21 Right – All Other In-Court Hours (continued)
Row 21 Right – In-Court Daily Total (continued)
Grand Total Hours (All Rows)
Expense Type 1 (1=Experts 2=Phone 3=Records 4=Transcripts 5=Travel 6=Other)
Expense Payee 1
Expense Amount 1
Expense Type 2 (1=Experts 2=Phone 3=Records 4=Transcripts 5=Travel 6=Other)
Expense Payee 2
Expense Amount 2
Expense Type 3 (1=Experts 2=Phone 3=Records 4=Transcripts 5=Travel 6=Other)
Expense Payee 3
Expense Amount 3
Expense Type 4 (1=Experts 2=Phone 3=Records 4=Transcripts 5=Travel 6=Other)
Expense Payee 4
Expense Amount 4
Expense Type 5 (1=Experts 2=Phone 3=Records 4=Transcripts 5=Travel 6=Other)
Expense Payee 5
Expense Amount 5
Total Expenses