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Case 5:18-md-02834-BLF Document 898 Filed 09/07/23 Page 1 of 1
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`Reset Form
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`CAND Pay.gov Application for Refund (rev. (cid:21)(cid:18)(cid:21)(cid:19)(cid:21)(cid:22))
`
`UNITED STATES DISTRICT COURT
`NORTHERN DISTRICT OF CALIFORNIA
`APPLICATION FOR REFUND (USDC-CAND PAY.GOV)
`
`PAY.GOV TRANSACTION DETAILS
`
`IMPORTANT:
`(cid:131) Complete all required fields (shown in red*); otherwise, your request may be denied and require resubmission.
`(cid:131) In fields 3-6, enter the information for the incorrect transaction (the one for which you are requesting a refund), not the correct
`transaction that appears on the docket. This information can be found in the Pay.gov screen receipt or confirmation email.
`
`5:18md02834-BLF
`
`1. Your Name:*
`7. Your Phone Number:
`Janet Y Walker
`213-680-8409
`2. Your Email Address: *
`8. Full Case Number (if applicable):
`janet.walker@kirkland.com
`3. (cid:53)(cid:72)(cid:70)(cid:72)(cid:76)(cid:83)(cid:87)(cid:3)(cid:36)(cid:74)(cid:72)(cid:81)(cid:70)(cid:92)(cid:3)(cid:55)(cid:85)(cid:68)(cid:70)(cid:78)(cid:76)(cid:81)(cid:74)(cid:3)(cid:44)(cid:39):*
`ACANDC-18464590
`(cid:133) Attorney Admission
`(cid:133) Civil Case Filing
`07/19/2023
`4. Transaction Date:*
`(cid:133) Audio Recording
`(cid:133) Notice of Appeal
`5. Transaction Time:*
`✔
`(cid:133) Pro Hac Vice
`6. Transaction Amount
`(cid:133) Writ of Habeas Corpus
`$ 505.00
`(Amount to be refunded):*
`10. Reason for Refund Request:* Explain in detail what happened to cause duplicate charges or no fee required.
`(cid:131) For a duplicate charge, provide the correct receipt number in this field.
`(cid:131) If you paid a filing fee in an abandoned case number, note that case number here (but e-file the refund request in the open case).
`(cid:44)(cid:81)(cid:3)(cid:82)(cid:85)(cid:71)(cid:72)(cid:85)(cid:3)(cid:87)(cid:82)(cid:3)(cid:70)(cid:75)(cid:68)(cid:81)(cid:74)(cid:72) (cid:72)(cid:73)(cid:76)(cid:79)(cid:76)(cid:81)(cid:74)(cid:3)(cid:80)(cid:72)(cid:81)(cid:88)(cid:3)(cid:86)(cid:72)(cid:79)(cid:72)(cid:70)(cid:87)(cid:76)(cid:82)(cid:81)(cid:86) (cid:69)(cid:72)(cid:73)(cid:82)(cid:85)(cid:72)(cid:3)(cid:86)(cid:88)(cid:69)(cid:80)(cid:76)(cid:87)(cid:87)(cid:76)(cid:81)(cid:74)(cid:3)(cid:71)(cid:82)(cid:70)(cid:88)(cid:80)(cid:72)(cid:81)(cid:87)(cid:3)(cid:73)(cid:82)(cid:85)(cid:3)(cid:73)(cid:76)(cid:79)(cid:76)(cid:81)(cid:74) had to (cid:85)(cid:72)(cid:86)(cid:87)(cid:68)(cid:85)(cid:87)(cid:3)(cid:87)(cid:75)(cid:72)(cid:3)(cid:73)(cid:76)(cid:79)(cid:76)(cid:81)(cid:74)(cid:3)(cid:86)(cid:72)(cid:86)(cid:86)(cid:76)(cid:82)(cid:81)(cid:3)(cid:68)(cid:81)(cid:71)(cid:3)(cid:85)(cid:72)(cid:86)(cid:88)(cid:69)(cid:80)(cid:76)(cid:87)(cid:3)(cid:83)(cid:68)(cid:92)(cid:80)(cid:72)(cid:81)(cid:87)(cid:17)
`
`8:09 pm
`
`9. Fee Type:*
`
`(cid:53)(cid:72)(cid:70)(cid:72)(cid:76)(cid:83)(cid:87)(cid:3)(cid:73)(cid:82)(cid:85)(cid:3)(cid:71)(cid:88)(cid:83)(cid:79)(cid:76)(cid:70)(cid:68)(cid:87)(cid:72)(cid:3)(cid:70)(cid:75)(cid:68)(cid:85)(cid:74)(cid:72)(cid:3)(cid:87)(cid:82)(cid:3)(cid:69)(cid:72)(cid:3)(cid:85)(cid:72)(cid:73)(cid:88)(cid:81)(cid:71)(cid:72)(cid:71)(cid:29)(cid:3)(cid:36)(cid:38)(cid:36)(cid:49)(cid:39)(cid:38)(cid:16)(cid:20)(cid:27)(cid:23)(cid:25)(cid:23)(cid:24)(cid:28)(cid:19)(cid:30)(cid:3)(cid:53)(cid:72)(cid:70)(cid:72)(cid:76)(cid:83)(cid:87)(cid:3)(cid:73)(cid:82)(cid:85)(cid:3)(cid:70)(cid:82)(cid:85)(cid:85)(cid:72)(cid:70)(cid:87)(cid:3)(cid:83)(cid:68)(cid:92)(cid:80)(cid:72)(cid:81)(cid:87)(cid:3)(cid:86)(cid:88)(cid:69)(cid:80)(cid:76)(cid:87)(cid:87)(cid:72)(cid:71)(cid:3)(cid:90)(cid:76)(cid:87)(cid:75)(cid:3)(cid:73)(cid:76)(cid:81)(cid:68)(cid:79)(cid:3)(cid:49)(cid:82)(cid:87)(cid:76)(cid:70)(cid:72)(cid:3)(cid:82)(cid:73)(cid:3)(cid:36)(cid:83)(cid:83)(cid:72)(cid:68)(cid:79)(cid:3)
`(cid:11)(cid:40)(cid:38)(cid:41)(cid:3)(cid:27)(cid:28)(cid:20)(cid:12)(cid:3)(cid:87)(cid:82)(cid:3)(cid:78)(cid:72)(cid:72)(cid:83)(cid:29)(cid:3)(cid:36)(cid:38)(cid:36)(cid:49)(cid:39)(cid:38)(cid:16)(cid:20)(cid:27)(cid:23)(cid:25)(cid:23)(cid:25)(cid:27)(cid:20)(cid:17)
`
`Efile this form using OTHER FILINGS (cid:738) OTHER DOCUMENTS (cid:738) APPLICATION FOR REFUND.
`(cid:57)
`View detailed instructions at: cand.uscourts.gov/ecf/payments. For assistance, contact the ECF Help Desk at 1-866-638-7829 or
`
`ecfhelpdesk@cand.uscourts.gov Monday -Friday 9:00 a.m.-4:00 p.m.
`
`FOR U.S. DISTRICT COURT USE ONLY
`
`Refund request:
`
`(cid:133) Approved
`(cid:133) Denied
`(cid:133) (cid:39)(cid:72)(cid:81)(cid:76)(cid:72)(cid:71)(cid:3)(cid:326)(cid:3)(cid:53)(cid:72)(cid:86)(cid:88)(cid:69)(cid:80)(cid:76)(cid:87)(cid:3)(cid:68)(cid:80)(cid:72)(cid:81)(cid:71)(cid:72)(cid:71)(cid:3)(cid:68)(cid:83)(cid:83)(cid:79)(cid:76)(cid:70)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3)(cid:11)(cid:86)(cid:72)(cid:72)(cid:3)(cid:85)(cid:72)(cid:68)(cid:86)(cid:82)(cid:81)(cid:3)(cid:73)(cid:82)(cid:85)(cid:3)(cid:71)enial)
`Approval/denial date:
`Request approved/denied (cid:69)y:
`Pay.gov refund tracking ID refunded:
`Agency refund tracking ID n(cid:88)(cid:80)(cid:69)(cid:72)(cid:85)(cid:29)
`Date refund processed:
`(cid:53)(cid:72)(cid:73)(cid:88)(cid:81)(cid:71)(cid:3)(cid:83)(cid:85)(cid:82)(cid:70)(cid:72)(cid:86)(cid:86)(cid:72)(cid:71)(cid:3)(cid:69)y:
`Reason for d(cid:72)(cid:81)(cid:76)(cid:68)(cid:79)(cid:3)(cid:11)(cid:76)(cid:73)(cid:3)(cid:68)(cid:83)(cid:83)(cid:79)(cid:76)(cid:70)(cid:68)(cid:69)(cid:79)(cid:72)(cid:12)(cid:29)
`
`Referred for OSC d(cid:68)(cid:87)(cid:72)(cid:3)(cid:11)(cid:76)(cid:73)(cid:3)(cid:68)(cid:83)(cid:83)(cid:79)(cid:76)(cid:70)(cid:68)(cid:69)(cid:79)(cid:72)(cid:12)(cid:29)
`
`

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