ADM-122 Alaska Billing Form for Post-Trial Juror Counseling Form

Download and use this form for filling up the billing form for Post-Trial Juror Counseling Fees.

Alaska Billing for Post-Trial Juror Counseling

Text Version of the Form

ALASKA COURT SYTEM
BILLING FORM FOR POST-TRIAL JUROR COUNSELING

Case Name

Case Number

Juror Who Received Counseling
(by juror number, not by juror name)

Name of Trial Judge

Counselor Information

Print or Type Counselor’s Name Tax I.D. Number

Address Phone Number

City State ZIP

Billing Information

Type of Session: Group Individual Number of Sessions

Dates of Counseling Sessions:

Hourly Rate x Total Hours = $0
Total Amount Billed

Date Counselor’s Signature

Court Use Only

Recommend Approval
Judge’s Signature Date
Approved by
Administrative Officer’s Signature Date

For Acct. Purposes: Ledger Code 41900030

ADM-122 (9/10) AS 12.45.018
BILLING FORM FOR POST-TRIAL JUROR COUNSELING