Report of Juvenile Dependency Bench Appointment(s) This notice is to inform the Bar Association of San Francisco Dependency Representation Program of appointments from the bench, including any Harris appointments, on a date on which I was not the assigned attorney of the day. PLEASE NOTE: You will not be eligible for payment for any court-appointed cases unless they have been reported to the Bar Association of San Francisco. Please return this form by fax to the Bar Association of San Francisco at (415) 782-8993. Name: _________________________________________ Appointment date: _______________________________ Case name (Minor) Dept. Case # Client type* Client name (if other than minor) 1 2 3 4 5 6 7 8 9 10 11 12 *E.g., minor, mother, father, de facto parent, etc. BASF-DRP 02/28/05 Bench Notice - Dependency American LegalNet, Inc. www.FormsWorkFlow.com