TUO- FSC-100 Appointment by: Honorable Date of Appointment: Services completed on: Type of Appointment: Court-Appointed Criminal Counsel Court-Appointed Dependency Counsel Arbitrator (Civil) Other: Investigator: Civil Conservatorship Family Law Guardianship Probate I, , hereby request payment of $, as reasonable compensation and expense relating to my court appointment for the above-entitled case. Court-appointed services rendered: (Itemize each service, including the date, the time devoted to, and the amount requested for each service.) OUT - OF - COURT WORK AND COURT APPEARANCES Date Type of Service - Limit One Service Per Line Time Amount See Page 3 for additional entries. CLAIM AND ORDER FOR COMPENSATION OF COURT-APPOINTED PROFESSIONAL SERVICES Form Adopted for Mandatory Use - Local Rules of the Superior Court of California Page 1 of 3 TUO-FSC-100 (Revised ) Court Appointed Professional (Name, Address and Phone No.): California Bar No.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF TUOLUMNE 60 N. Washington Street, Sonora, CA 95370 (209) 533-5563 41 W. Yaney Avenue, Sonora, CA 95370 (209) 533 - 6975 Case Number: CLAIM AND ORDER FOR COMPENSATION OF COURT-APPOINTED PROFESSIONAL SERVICES Space below for use of Court Clerk only Case Title: (Abbreviated) American LegalNet, Inc. www.FormsWorkFlow.com CLAIM AND ORDER FOR COMPENSATION OF COURT-APPOINTED PROFESSIONAL SERVICES Form Adopted for Mandatory Use - Local Rules of the Superior Court of California Page 2 of 3 TUO-FSC-100 (Revised ) EXPENSES Date(s) Item(s ) Amount TOTAL EXPENSE(S) REQUESTED: $ Total compensation requested (from Page One ): $ Total compensation requested (from Page Three ): $ TOTAL AMOUNT OF CLAIM: $ Each of the above professional services and expenses was reasonably required in the discharge of my legal duties in this case and I have not received, nor have I promised, any compensation for such services and expenses from any source other than this Court. I certify under penalty of perjury that the foregoing us true and correct, and this certification was executed on at , California. Signature of Claimant ORDER Good cause appearing, the Court finds that the reasonable compensation for professional services necessarily performed, and for the expenses necessarily incurred, by the Claimant pursuant to appointment by this Court is $; and IT IS ORDERED that such sum be paid to: . (Claimant, insert sum) (Claimant, insert your name here) DATED: JUDGE OF THE SUPERIOR COURT American LegalNet, Inc. www.FormsWorkFlow.com CLAIM AND ORDER FOR COMPENSATION OF COURT-APPOINTED PROFESSIONAL SERVICES Form Adopted for Mandatory Use - Local Rules of the Superior Court of California Page 3 of 3 TUO-FSC-100 (Revised ) (Itemize each service, including the date, the time devoted to, and the amount requested for each service.) OUT - OF - COURT WORK AND COURT APPEARANCES - CONTINUED FROM P AG E ONE Date Type of Service - Limit One Service Per Line Time Amount American LegalNet, Inc. www.FormsWorkFlow.com