[ ] ORIGINAL [ ]DUPLICATE COURT VERIFICATION LONG FORM FOR COURT-APPOINTED PARENT222S ATTORNEY IN FC-S CASES INSTRUCTIONS037 1.036 The attorney shall complete the following information below before submission to the Court Clerk at the hearing/trial:037 < Case Name < < Case No. < Name of Attorney Date of Hearing037 Name of Judge037 < < Type of Hearing037 2.036 The Court Clerk shall verify the start and end times when on the record during the hearing/trial, sign this form and return the form to the attorney. Please use one form per case per day. 3.036 The attorney shall attach this Court Verification Long Form to his/her Invoice for Attorney222s Fees and Costs. CASE NO.: FC-S No. CASE NAME: NAME OF ATTORNEY: DATE OF HEARING: SCHEDULED HEARING TIME: TYPE OF HEARING: START TIME END TIME SUB-TOTAL START TIME END TIME SUB-TOTAL TOTAL HOURS/MINUTES = TOTAL HOURS/MINUTES = CLERK222S SIGNATURE: PRINT CLERK222S NAME: NAME OF JUDGE: In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws,if you require accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Courtoffice by telephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10)days prior to your hearing or appointment date. FC Adm 2/8/17 Court Verification Long Form for Court Appointed Parent222s Attorney in FC-S Cases 003003 American LegalNet, Inc. www.FormsWorkFlow.com