Voucher Form

Voucher Request for Payment

FY2025
**Instructions for submitting vouchers**
- Vouchers must be received by 5 p.m. on Wednesday to be considered for payment on Friday. Cases with a disposition date older than 90 days may be rejected for payment. IF YOU HAVE CASES THAT CLOSED OUT MORE THAN A YEAR AGO, PLEASE CONTACT KATY BEFORE USING THIS FORM. WE WILL NEED TO ESTABLISH A BILLING PLAN.
- If you use the new rates on a case opened after 5/1/23 but the client has pending charges before 5/1/23, you may only bill the new rates on the new cases received after 5/1/23.
- The form is interactive and will calculate the running total of all your cases and generate a total on the last page.
- Your attached Excel/PDF time sheet must state the $ amount requested per case listed and the $ total voucher amount. The case $ values and $ total sum on your time sheet must match the $ values on this form to be approved.
- A flat rate can be used once per client caseload, not per client's case. Flat rates do not require an attached timesheet, but you must include a (0.1 x $ hourly rate) fee for each subsequent case and include it in this voucher form. E.g. $400 flat rate on case 1, $11.50 on case 2, total voucher request $411.50.
Attorney Name*
Email
CASE INFORMATION
Defendant's Name*
DD/LS Matter Number*
Remember to close out all resolved cases in LegalServer
Date of Assignment*

MonthDayYear
Date of EARLIEST assignment for caseload
Date of Initial Contact Attempt*

MonthDayYear
**Reminder: This is the date of your first ATTEMPT to contact the client; not date of first conversation
Calculated Days from Assignment to Initial Contact Date
**If negative, check reported dates
Method of Initial Contact Attempt
Date of Disposition (if case has closed)

MonthDayYear
**Leave blank if case has been re-assigned
Reason for Vouchering*
**2nd Chair Attorneys: Select '2nd Chair Assignment', regardless of case outcome
Does the client have multiple charges?*

YesNo

SINGLE CASE VOUCHER

Use this section if you only have one case to bill on.
Are you billing at a flat rate?

Felony $400Misd $250
CASE NUMBER (Single Case)*
CASE OFFENSE LEVEL (Single Case)*
**Remember to select 'MH' tag for Mental Health clients
COURT (Single Case)*
**Select court case was filed in at time of case resolution
RESULT (Single Case)*
$ TOTAL $ (Single Case)*

MULTIPLE CASE VOUCHER

Use this section if your client has several cases.
Are you billing at a flat rate?

Felony $400Misd $250
CASE NUMBER #1*
CASE OFFENSE LEVEL*
**Remember to select 'MH' tag for Mental Health clients
COURT (Single Case)*
**Select court case was filed in at time of case resolution
RESULT*
$ Total for Case #1*
Do you have another case to add?*

YesNo

Case #2
CASE NUMBER #2*
CASE OFFENSE LEVEL*
**Remember to select 'MH' tag for Mental Health clients
COURT*
**Select court case was filed in at time of case resolution
RESULT*
$ Total for Case #2*
Do you have another case to add?*

YesNo

Case #3
CASE NUMBER #3*
CASE OFFENSE LEVEL*
**Remember to select 'MH' tag for Mental Health clients
COURT*
**Select court case was filed in at time of case resolution
RESULT*
$ Total for Case #3*
Do you have another case to add?*

YesNo

Case #4
CASE NUMBER #4
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #4
Do you have another case to add?

YesNo

Case #5
CASE NUMBER #5
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #5
Do you have another case to add?

YesNo

CASE NUMBER #6
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #6
Do you have another case to add?

YesNo

CASE NUMBER #7
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #7
Do you have another case to add?

YesNo

CASE NUMBER #8
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #8
Do you have another case to add?

YesNo

CASE NUMBER #9
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #9
Do you have another case to add?

YesNo

CASE NUMBER #10
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #10
Do you have another case to add?

YesNo

CASE NUMBER #11
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
$ Total for Case #11
Do you have another case to add?

YesNo

CASE NUMBER #12
CASE OFFENSE LEVEL
**Remember to select 'MH' tag for Mental Health clients
COURT
**Select court case was filed in at time of case resolution
RESULT
If your client has more than 12 charges, please complete this voucher and submit a second voucher with the remaining charges.
$ Total for Case #12

FINAL VOUCHER AMOUNT

Vouchers will not be accepted without a time sheet. Flat rate vouchers do not require a timesheet. Thank you for all your hard work and for being on the LPDO panel!
Total Voucher Request*
This is what will be deposited to your account (it must match your billables time sheet).
Time Entries - Spreadsheet Upload

Cancelof
Additional Info or Success Story
By submitting this voucher, you affirm that all information is accurate and you have not previously received payment for this caseload.
Should be Empty:

Voucher Request for Payment

**Instructions for submitting vouchers**

CASE INFORMATION

SINGLE CASE VOUCHER

MULTIPLE CASE VOUCHER

Case #2

Case #3

Case #4

Case #5

FINAL VOUCHER AMOUNT

Instructions for submitting vouchers