ATTACHMENT FM-1110 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY 201 North First Street, San José, CA 95113 191 North First Street San José, California 95113 Family Justice Courthouse PETITIONER: RESPONDENT: OTHER PARENT/ CLAIMANT: APPLICATION AND ORDER FOR EXPERT WITNESS FEES (FAMILY CODE SECTION 3112) APPLICATION AND ORDER FOR DEPOSITION FEES (GOVERNMENT CODE SECTION 68096.1(d)) CASE NUMBER: DEPARTMENT NUMBER: FCS NUMBER: APPLICATION I, , declare under penalty of perjury, as follows: 1. I am an Evaluator/Screener for the Superior Court of California, County of Santa Clara Family Law Division. 2. I have been ordered by the Court to perform an evaluation/screening involving custody and visitation investigation in the above listed matter and, in conjunction with such evaluation I have been required to provide testimony as an expert witness on 3. The assessed fee for such testimony is $160.00 per hour. I spent cost for the testimony is $ . hours testifying. The total . Dated: Signed: Screener/Evaluator ORDER IT IS ORDERED that: 1. Each party shall pay $ , which is one half of the Family Court Services fee. The fees are due and payable within 30 days from the service of this Order, unless a fee waiver of these specific fees in granted. 2. Other Orders: Dated: Judicial Officer FM-1110 NEW 07/01/11 EXPERT WITNESS FEE APPLICATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com