Name of Person Filing: ___________________________________________ Address: ___________________________________________ City, State, Zip Code: ___________________________________________ Telephone Number: ___________________________________________ Attorney Bar Number (if Applicable)___________________________________ Representing: Self or Attorney for _____________________________ FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of the (check one or both) Guardianship and/or Conservatorship of: Case No:_______________________________ FEE STATEMENT AND PROOF OF MAILING ______________________________________ an Adult 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 NUMBER OF HOURS BILLED: Total number of hours billed is __________________ X $___________________ per hour = $___________________ Revised: 8/29/2012 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No.__________________________________ PROOF OF MAILING: A copy of this management plan was mailed or delivered to the following persons: NAME ADDRESS Today's Date: _____________________________ Your Signature: ____________________________ Revised: 8/29/2012 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com