IN THE COURT OF THE EIGHTH JUDICIAL CIRCUIT, IN AND FOR IN THE INTEREST OF: COUNTY, FLORIDA. CASE NO: DIVISION: DEPENDENCY A Minor Child. _________________________/ VERIFIED MOTION TO COMPENSATE AND DISCHARGE SPECIAL COURT APPOINTED ATTORNEY COMES NOW, , ESQUIRE, the undersigned affiant, and respectfully moves the Court to enter an order awarding compensation and discharge for services rendered as a Special Court Appointed Attorney in the above-captioned cause. In support of the motion, the undersigned would show: 1. Name of client(s): 2. Date appointed: 3. Presiding Judge: The Honorable 4. Opposing counsel: 5. Date case closed & disposition of case: (If not closed, attach sheet explaining why). 6. Type of cause: Dependency 7. The time records attached to this verified motion are true and correctly represent the time expended by me in the representation of the above-named client. 186 2000 © American LegalNet, Inc. 8. In-court time: (in hours and tenths of hours): subtotal of hours = x $60.00 per hour= 9. Out-of-court time: (in hours and tenths of hours): subtotal of hours= x $50.00 per hour= 10. Reimbursable Costs (items and amounts, all receipts must be attached: subtotal of reimbursable costs= Grand total funds requested (In-Court fees, Out-of-Court fees, & reimbursable costs) = 187 2000 © American LegalNet, Inc. 11. The funds requested on this verified motion are true and correctly state the time expended by me in the representation of the above-named defendant. Attorney's Signature: Print Name Florida Bar # Mailing Address: , 200 The foregoing instrument was acknowledged before me this _____ day of , by who is personally known to me or who has produced a Florida driver's license as identification and who did take an oath. (type or print name) Notary Public # (SEAL) My commission expires: 188 2000 © American LegalNet, Inc.