Alaska Screening Investigation Billing Form

Download and Use this form for Billing for the Screening Investigation in the Court of Alaska.

Alaska Screening Investigation Billing Form

Text Version of the Form

ALASKA COURT SYSTEM
SCREENING INVESTIGATION BILLING FORM

Case Information
Respondent:
Case Number:
Judicial Officer:

Provider Information
Name: Company:
Phone: Tax ID No.:
Address:

Screening Investigation
Date of Appointment:
Date of Screening Report:
Services Provided (please use additional sheets if necessary): Time (in tenths of hours)
1.
2.

3.
4.

5.

Amount Submitted for Payment $

I certify that my services in this case are completed and the facts stated above are true to the
best of my knowledge and belief.

Date Provider Signature

FOR COURT USE ONLY

Recommended for approval: $

Date Judicial Officer Signature

Amount approved: $

Date Area Court Administrator

ADM-124 (6/11)(cs) AS 47.30.700
SCREENING INVESTIGATION BILLING FORM