Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Licensed Fiduciary Number: ____________________________________ Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the (check one or both) Guardianship and/or Conservatorship of Case Number: PB FEE STATEMENT AND PROOF OF MAILING an Adult or a Minor INSTRUCTIONS: This document must be completed in all cases where fees are charged. All activities for which fees are charged must be specifically listed, such as telephone calls, meetings, staff meetings, conferences, document preparation, work in house or files, personal visits, and so forth. STATEMENT OF FEES FOR SERVICES: The following is a statement of fees for services rendered from (date) to (date). DATE DESCRIPTION AND SERVICE PROVIDER TIME AMOUNT CHARGED NUMBER OF HOURS BILLED: Total number of hours billed is x$ per hour = $ TOTAL CHARGE © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED PBGCF93f 121212 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Case No. PB PROOF OF MAILING: A copy of this document was mailed or delivered to the following persons: NAME ADDRESS Today's Date: Your Signature: © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED PBGCF93f 121212 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com