Request For Payment For Qualified Interpreter
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1REQUEST FOR PAYMENT
FOR QUALIFIED INTERPRETER
STATE OF SOUTH CAROLINA
)
IN THE COURT OF
)
________________________
COUNTY OF
_________________________
)
)
JUDICIAL CIRCUIT
__________________________________
)
No.
Plaintiff
)
)
CASE NO. ________________________
vs.
)
)
__________________________________
)
Defendant
)
Pursuant to S.C. CODE ANN. Sections 15-27-15, 15-27-155, or 17-1-50, claim is hereby made for
compensation of the services of a qualified interpreter who has been approved by the Court. Note: Interpreters
will receive an hourly rate for services rendered in one day (not per case), with a two-hour minimum. If
interpreting services exceed one day, the hourly rate per hour will be paid for actual time of services rendered
(to the nearest quarter-hour).
Hours at $
per hour
$
/
To
/
at $0.535 =
$
Miles
from
City
County
City
County
TOTAL
$
.
Mileage may be reimbursed at the official state rate when assignment is outside residence county or place of business
I hereby certify that this is a true and correct statement of my mileage and services rendered for interpreting the court proceeding to a
deaf or non-English speaking person who is a juror or a party to the proceeding or a witness therein.
Signature of Interpreter
Printed Name of Interpreter
I am (check one):
S.C. State Employee
Privately Employed
(State employees attest by their signature that they did not perform these services as part of their normal duties or on State time.)
CHECK WILL BE MADE PAYABLE AND MAILED TOTHE INDIVIDUAL OR FIRM LISTED BELOW.
SOCIAL SECURITY OR F.E.I. NUMBER MUST BE INCLUDED. IF A W-9 IS NOT ON FILE, PLEASE ENCLOSE.
NAME:
_________________________________
APPROVED BY: Presiding Judge
ADDRESS: ________________________________
__________________________________________
TELEPHONE NO. __________________________
_________________________________________________________
S. S. # or F. E. I. #:________________________
Printed Name of Judge
Date: __________________________________________
SCCA/263 (1/2017) NOTE: Original form or Certified True Copy only. Forms not in compliance will be returned.
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