EXHIBIT 6 Mother's Name (Last, First) In Re the Matter of: CASE NO. DECLARATION OF COUNSEL RE ATTORNEYS' FEES . (e.g., mother, father, minor, de facto parent.) In this action I am the attorney for Minor(s) age(s): The stage of proceedings being billed is to (e.g., Detention or Detention to Jurisdiction; Disposition to DSR, Post PPH, Other). Mother's Attorney: Minor's Attorney : Date of Appointment: Before the Honorable: Brief narrative statement describing billing activity (optional). Father's Attorney: Other Attorney(s): (e.g. for de facto parent, relative) Department (where case is being heard for current bill): Judge/Commissioner Presiding. . Situation of client: I have not received payment from any outside source except as follows: AMOUNT: RECEIVED FROM: PURPOSE: I declare under penalty of perjury under the laws of the State of California that the foregoing, and the information provided on the attachments, is true and correct. I agree to produce, upon request, records concerning the specific times and total hours billed to the Court for in- and out-of-court services as requested. Date Printed Name Signature BASF-DRP 1/10/11 Attorney Billing Form - Dependency 54 American LegalNet, Inc. www.FormsWorkFlow.com