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UNITED STATES COURT OF APPEALS
FIFTH JUDICIAL CIRCUIT
APPELLATE CONFERENCE ATTORNEYS OFFICEJOSEPH L. S. ST. AMANT
SENIOR APPELLATE CONFERENCE ATTORNEY600 Camp Street
New Orleans, LA 70130
504.310.8506
CJA Appointed Attorneys Panel Attorney Data for IRS 1099 Tax Reporting
Please return this form along with your first CJA voucher of a given calendar year. After that time, you need only submit a new form if your information changes. We cannot pay vouchers without this form on file.
Please return this form in one of three ways:
Via facsimile transmission to Attn: Kami Patterson at (504) 310-7583, via email to Kami_Patterson@ca5.uscourts.gov, or by mail to:
Attn: Kami Patterson
United States Court of Appeals, Fifth Judicial Circuit
Appellate Conference Attorneys Office
600 Camp Street, Room 229
New Orleans, LA 70130
ATTORNEY NAME:
LAW FIRM: (If Applicable)
ADDRESS:
(WHERE PAYMENTS
SHOULD BE SENT)TELEPHONE:
FAX:
EMAIL:
SSN:
TAXPAYER ID OF LAW FIRM: (Provide Only When Income Is Being Reported To A Law Firm)
Report income under my social security number and name as indicated above.
Report income to the law firm with which I am affiliated, as indicated above.
NOTE: Your Social Security Number is required regardless of how income will be reported to the IRS.
___________________________________________________________________SIGNATUREDATE
The Administrative Office of the U.S. Courts payment system identifies CJA appointed attorneys solely by their social security number. To protect the attorney's privacy and alleviate the courts' work of redacting social security numbers before copies of the forms are made available to the public as required by Public Law 105-119, social security number are not printed on the CJA 20 and 30 forms. Income will be reported to the IRS in the manner directed by the appointed attorney.
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