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2. County Administrative Office Indigent Defense Billing
4. Your Name/Business Name
5. Remit-To Address
7. Invoice Date
8. Invoice Number
   Use a different invoice number for each new invoice
9. Invoice Total
11. Defendant Name (if multiple, list in description)
12. Case Number(s)
14. Case Type(s)

    1. Criminal (Adult)
    2. Juvenile Dependency (300)
    3. Juvenile Delinquency (600)
    4. Family Law
    5. Civil
    6. Other (explain in description)
15. Charge Type(s)

    1. Misdemeanor
    2. Felony - Not Homicide/Life Term/Top Case
    3. Felony - Life Term/Top Case
    4. Felony - Homicide
    5. Contempt
    6. Other (explain in description)
17. Date
18. Description
19. Hours
20. Charges
22. Date
23. Description
24. Hours
25. Charges
27. Date
28. Description
29. Hours
30. Charges
32. Date
33. Description
34. Hours
35. Charges
37. Date
38. Description
39. Hours
40. Charges
42. Date
43. Description
44. Hours
45. Charges
47. Date
48. Description
49. Hours
50. Charges
52. Total Expenses
53. Total Hours
54. Total Charges
56. File Upload*
    Attach funding order(s) and copies of any receipts for lodging, meals, airfare, rental cars, or other expenses.
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field