Arbitrators Fee Statement
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Arbitrators Fee Statement Form. This is a California form and can be use in Riverside Local County.
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Tags: Arbitrators Fee Statement, California Local County, Riverside
Superior Court of California
County of Riverside
SUPERIOR COURT OF CALIFORNIA
COUNTY OF RIVERSIDE
)
)
)
vs.
)
)
Defendant(s)
)
_____________________________ )
Plaintiff(s)
Case No. ____________
ARBITRATOR’S FEE STATEMENT
Pursuant to local court policy, I am submitting this fee statement requesting payment of $150 for
my services in conducting arbitration proceedings.
Date(s) of Hearing: ________________________________________
Date the Award/Settlement was filed: __________________________
Make check payable to:
________________________________
Signature of Arbitrator
________________________________
Name
Personal or
Business
________________________________
Printed Name of Arbitrator
________________________________
Mailing Address
________________________________
Phone Number
_________________________________
City
State
Zip
_________________________________
Identification Number (Required)
Social Security # if personal or
Tax ID# if business
**********BELOW IS FOR COURT USE ONLY**********
I certify that this fee application has been submitted in compliance with court policy and the
Court Executive Office is hereby ordered to issue payment in the amount of $150 payable to
the above named person for services rendered in this case.
Amount Authorized $__________________
Authorized by: ________________________
Printed Name: _____________________
Date: _______________________________
Phone #: _________________________
Effective January 1, 2008
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