UNITED STATES DISTRICT COURT - DISTRICT OF NEBRASKA

Court Reporter/Transcriber Statement of Services

Name/Firm (Payee):	Invoice/Contract #:

Address: Soc Sec/Tax ID# (Payee):___________________________

City, State, Zip: Phone #:

E-Mail Address:	Fax#:

COURT REPORTING:

Case #	Case Caption Judge Date Time: (From) Time: (To) Hours CM/ECF Filing #

Full Days	@	$ *

Half Days	@	$ *

__________	Overtime	@	$____________ *

Cancellation Fee	@	$ *

Total $

"I certify that I performed court reporting services, as claimed above, and that the fees charged are in accordance with the contract and local court guidelines."

Court Reporter Signature	Date

TRAVEL AND/OR OTHER EXPENSES: (if applicable)

Total	$

TRANSCRIPTS:

Case #	Judge Ordered By Date Ordered Date Filed Filing # Type Pages Rate Total

Total $

"I certify that the transcript fees charged were ordered by the court and the page format used comply with the requirements of the court and the Judicial Conference of the United States."

Total Amount Claimed $

Transcriber Signature	Date

Reviewer Signature	Date

Mail Invoice To:

Clerk, U.S. District Court

Attn: Deb Wesely, Shared Services

111 S. 18th Plaza, Ste 1152	Forms and Court Plans located at www.ned.uscourts.gov

Omaha, NE 68102-1322	Last Revision Date: 11/02/2007