UNITED STATES ATTORNEYS Request, Authorization, and Order for Services of Expert Witness, Litigative Consultant, or ADR Neutral 1. Requesting Official (Name & Title) ture of Requesting Official 3. Point of Contact (Name and Tel.) 4. Date of Request a — = Telephone: 5. Preparer (Name & Tel.) 6. Originating Office (Name & Address) |7. Case Name, Court & Ct. Docket No. | 8. DJ File No./USAO No. U.S. Attorney's Office, SDNY US v. Maxwell, 20 Cr. 330 = 2018R01618 9. Contractor (Name and Tel.) 10. Contractor Mailing Address 11. Contractor TIN or SSN (individual) 12. Contractor Specialty Taylor Trial Consulting a. Jury consulting services Telephone: 13. Reason for Request (Place an “X" in the applicable Box in the Left Column) 13.a. Expert Testimony on Behalf of U.S. 13.b. Deposition Conducted by DOJ Attorney 13.c. Medical Examination of Plaintiff/Witness/Defendant in Contemplation of Testimony on Behalf of U.S. 13.d. Examination Under 18 USC 4241, Mental Competency to Stand Trial Only 13.e. Dual Purpose Psychiatric Examination (Time of Offense and Competency to Stand Trial) on the motion of: 13.f. ADR Neutral Services x 13.g. Litigative Consultant Services 13.h. Other (explain below): Attach the Statement of Work to this Form 14. Negotiated Contractor Rates, Estimated Expenses, and Performance Dates (Note: Expenses incurred must be supported by receipts) | 14.a. Examine Case 14.b. Prepare Testimony 14.c. Court Testimony 14.d. Deposition 14.e. Litigative Consultant/Neutral 14.f. Per Diem (if not part of fee) 14.g. Privately Owned Vehicle (NTE coach rate) 14.h. Common Carrier Transportation Via GTA 14.i. Common Carrier Transportation Reimbursed 14,j. Miscellaneous 14.k. mat 15. Submit Invoices & EFT Information to: 16. Payment will be made by: (Place an *X" in the applicable Box and fill-in if not JMD/Finance) U.S. Attorney's Office, SDNY Budget & Fiscal Unit : ; A s Form USA-47 (Revised 5-2008) Page 1 of 2 EFTA00032622