CACD | CJA 29

CJA 29
Application for Authorization to Obtain CJA Services


THIS FORM ONLY WORKS WITH INTERNET EXPLORER.


Counsel or Defendant Proceeding Pro Se: If the name is not listed, enter the last name and first name in the fields below.
Last NameExample: Smith: First Name & Middle InitialExample: Jane M:
Email:
Case Number:
Off #2=Los Angeles, 5=Riverside, 8=Santa Ana
Year
Type
Docket #Numbers only. Example: 134
Judge
Defendant #Numbers only. Example: 4: Please leave Defendant number at 'zero (0)' for non-CR cases.
Case Title: v.
Person Represented:
Last NameExample: Doe: , First & Middle Names Example: John C:
CJA Service Type and Services Requested:
Name of Individual/Company to be Authorized to Provide CJA Service Requested:
Name:
c/o:
Address:
City/State/Zip: 		Phone:
Fax:
Email:
Amount Requested:
Rate/FeeNumbers only. Example: 1500: # of HoursNumbers only. Example: 30:
All Amounts Previously Authorized:
Rate/FeeNumbers only. Example: 1500: # of HoursNumbers only. Example: 30:
Description of work:
Declaration in support the funds requested: (Include points and authorities along with a detailed itemized description of each task to
be completed with the number of hours required to complete each itemized task.)


Upload additional materials in support of application: (Combine all materials as one PDF document.)

I, being the above listed counsel or defendant proceeding pro se, certify that the provider of the services sought presents no potential for conflict or that any such conflict has been waived and such waiver approved by the court.

Please make sure all information is correct before submitting the application. Application cannot be edited after submittal.