Attorney Fee Election
Attorney Fee Election Form. This is a Kentucky form and can be use in Workers Comp.
Tags: Attorney Fee Election, 109, Kentucky Workers Comp,
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Form 109 Attorney Fee Election Adopted March 15, 1995 Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : DEPARTMENT OF WORKERS CLAIMS FRANKFORT, KENTUCKY: 40601 : State's Defendant(s) :Number ...................................................... STANDARD FORM FOR ATTORNEY FEE ELECTION For: File: Carrier: Employer: Carrier's File No. THE PEOPLE OF THE STATE OF NEW YORK TO I hereby certify that my attorney has fully explained to me my options regarding the payment of attorney fees. I hereby select the following method: GREETINGS: A. _____ I elect to pay my attorney's fee out of my personal funds. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at B. _____ I elect to have any attorney's fee paidthe a lump sum Court have each of my in and to located at County of weekly benefits equally reduced until the defendants have recouped the amount of my in room , on the day of , 20 , at o'clock in the noon, and at any recessed attorney's fee. or adjourned date, to testify and give evidence as a witness in this action on the part of the C. _____ My case has been settled for a lump sum. I elect to pay my attorney's fee out of my lump sum settlement. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued forplaintiff herein, being duly and all damages sustained as a , a maximum penalty of $50 sworn, states that result statement of the comply. election is true. of your failure to foregoing the Witness, Honorable Court in County, , one of the Justices of the day of , 20 Plaintiff SUBSCRIBED AND SWORN to before me this , 20 . (Attorney must sign above andof name below) day type Attorney(s) for Notary Public or other authorized officer I hereby certify that I have fully explained the provisions Office and P.O. Address client. of KRS 342.320 to my Attorney for Plaintiff Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com