Form Gc-12 - Claim For Investigation Or Expert Witness Fees - Galveston County, Texas
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1CLAIM FOR INVESTIGATION OR EXPERT WITNESS FEES
THE STATE OF TEXAS
IN THE _________________________
VS.
OF GALVESTON COUNTY, TEXAS
____________________________________
DATE OF APPROVAL BY COURT TO INCUR EXPENSE: ___ ___/___ ___/___ ___ ___ ___
DEFENSE COUNSEL:___________________________________________________________
CHECK BOX IF REVOCATION OF PROBATION
OFFENSE
CAUSE NUMBER
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
AMOUNT BILLED
JUDICIAL AUTHORIZATION
INVESTIGATION EXPENSE:
)
(PRIOR COURT APPROVAL REQUIRED AND INVOICE MUST BE ATTACHED
EXPERT WITNESS EXPENSE:
(PRIOR COURT APPROVAL REQUIRED AND INVOICE MUST BE ATTACHED)
TOTAL
I, the undersigned Investigator/Expert Witness, having been approved by the Court to perform services necessary to the
defense of the above referenced Defendant request payment in accordance with the laws of the State of Texas. I further
affirm to the truth and correctness of the above listed services performed, and I have not received, nor will I receive, any
other monies, or anything else of value for said services.
________________________________________________
___ ___/___ ___/___ ___ ___ ___
INVESTIGATOR/EXPERT WITNESS SIGNATURE
INVESTIGATOR/EXPERT WITNESS INFORMATION (PLEASE PRINT - MUST BE LEGIBLE)
NAME:____________________________________________________________________________
MAIL ADDRESS:___________________________________________________________________
CITY:______________________STATE:_____________ZIP:__________________
TELEPHONE NUMBER (_____)________-____________SOCIAL SECURITY NUMBER_____-______-_______
TO THE COMMISSIONERS COURT OF GALVESTON COUNTY, TEXAS:
I, the undersigned Judge of Galveston County, Texas, do hereby certify that the defendant in the above cause(s) has on file with this
Court an affidavit reflecting indigency and an inability to afford counsel, that the attorney shown above has been appointed to
represent the defendant, that the Investigator/Expert Witness shown above has performed the listed services and that the said
Investigator/Expert Witness is entitled under Article 26.05, Texas Code of Criminal Procedure, to be paid from the General Fund of
Galveston County, Texas, for services performed in an amount shown above.
___ ___/___ ___/___ ___ ___ ___
_________________________________________________
Judge
{FORM #GC-12}
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