SDSC D-137 (Rev. 5/09) DECLARATION AND ORDER FOR PAYMENT OF Fam. Code 247247 3150-3153; CRC, rules 5.240-5.242 ATTORNEY FEES AND COSTS OF MINOR222S COUNSEL SDSC Local Rule 5.12.7 Page 1 of 2 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PETITIONER(S) RESPONDENT(S) THIRD PARTY DECLARATION AND ORDER FOR PAYMENT OF ATTORNEY FEES AND COSTS OF MINOR222S COUNSEL CASE NUMBER I, , declare: (Attorney Name) 1. I am an attorney duly licensed to practice law within the State of California, practicing in the County of San Diego. The last four digits of my tax ID number are: . My Phoenix vendor number is: . 2. On , I was appointed by the San Diego Superior Court to represent in the above-entitled action at the rate of $60.00 per hour. 3. I have timely filed the Declaration of Counsel for a Child Regarding Qualifications (JC Form #FL-322). 4. a. As minor222s counsel, I understand I must submit this declaration at every review hearing or no less than every 90 days if there is no pending review hearing. I further understand that failure to timely submit this declaration may result in any billings older than 180 days being forfeited. I further understand that the court shall be fully reimbursed before any payments are madeb. has performed psychological evaluation(s) on and/or provided expert testimony in this case. Attached is his/her invoice(s) 5. My representation in this case is complete. continuing. 6. For the period to , I request payment by the San Diego Superior Court for the following: a. Fees (number of hours x $60/hour): $ . b. Costs: $ . c. Total Fees and Costs: $ . 7. The total amount claimed in this case to date is $ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature American LegalNet, Inc. www.FormsWorkFlow.com SDSC D-137 (Rev. 5/09) DECLARATION AND ORDER FOR PAYMENT OF Fam. Code 247247 3150-3153; CRC, rules 5.240-5.242 ATTORNEY FEES AND COSTS OF MINOR222S COUNSEL SDSC Local Rule 5.12.7 Page 2 of 2 CASE TITLE CASE NUMBER ORDER The court, upon reviewing the declaration above dated , and good cause appearing, orders that the San Diego Superior Court pay to minor222s counsel the sum of $ ; and to the sum of $ . Minor222s counsel forfeits the following amount of fees and costs for failure to timely file the Declaration and Order for Payment of Attorney Fees and Costs of Minor222s Counsel (SDSC Form #D-137): $ . IT IS SO ORDERED. Date: Judge/Commissioner of the Superior Court For Office Use Only Order to reimburse in effect dated . Distribution: Orig. to file. cc: Minor222s Counsel Admin. Services C-44 Petitioner Respondent Third Party Entered in database. Entered in fiscal system. Date Initials Date Initials American LegalNet, Inc. www.FormsWorkFlow.com