BILL FOR SERVICES RENDERED STATE-INITIATED PATERNITY ACTIONS JD-FM-91 Rev. 12-96 STATE OF CONNECTICUT SUPERIOR COURT www.jud.state.ct.us BILL I.D. NO. INSTRUCTIONS TO ATTORNEY Complete this form for each case in which you were appointed by the court to act as the attorney for an indigent defendant in a state-initiated paternity action. This form constitutes your bill for services rendered. Obtain form CO-17 from the clerk's office and complete it, including the amount of bill below. Mail form CO-17, with this form attached, to the clerk of the court location where the services were rendered. NAME OF INDIVIDUAL ATTORNEY (First, middle init., last) JURIS NO. DATE(S) SERVICES RENDERED MAILING ADDRESS OF ATTORNEY NAME AND ADDRESS OF COURT LOCATION WHERE SERVICES WERE RENDERED NAME OF CASE NAME OF JUDGE OR MAGISTRATE NO. OF CHILDREN Case disposed BEFORE complete trial as to: NAME(S) OF CHILDREN Case disposed AFTER complete trial as to: DOCKET NO. NAME(S) OF CHILDREN The fees for all counsel appointed by the court to represent indigent putative fathers in state-initiated paternity actions shall be $220 for services culminating in a disposition other than a disposition after a complete trial, or $440 for services culminating in a disposition after a complete trial. If the defendant is claimed to be the father of two or more children named in a single petition, the fee will be fixed in accordance with the above for the first child and 50% of such fee for each additional child. There shall be no additional fees for depositions, motions, jury trials or any other legal work in such cases. SIGNED (Individual attorney) AMOUNT OF BILL DATE SIGNED American LegalNet, Inc. www.FormsWorkflow.com