Request For Payment Of Court Appointed Attorney Fees (Juvenile)
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Request For Payment Of Court Appointed Attorney Fees (Juvenile) Form. This is a Michigan form and can be use in Macomb Local County.
Loading PDF...
Tags: Request For Payment Of Court Appointed Attorney Fees (Juvenile), Michigan Local County, Macomb
REQUEST FOR PAYMENT
OF COURT APPOINTED
ATTORNEY FEES
(JUVENILE – DIVERSION CASES)
REQUIRED INFORMATION – PLEASE PRINT OR TYPE:
Attorney Name
Bar No.
Street Address
Tax I.D. No.
Phone Number
Fax Number
City, State, Zip
Macomb County Vendor No. (required)
Hearing (Date, Type)
On ____________________I was appointed for a ¨ half day ($150) ¨ full day ($300) to:
(date of service)
1. Represent:
Circuit Court Case Number:
In the matter of:
2. Represent:
Circuit Court Case Number:
In the matter of:
3. Represent:
Circuit Court Case Number:
In the matter of:
4. Represent:
Circuit Court Case Number:
In the matter of:
5. Represent:
Circuit Court Case Number:
In the matter of:
I have not received compensation from any source in handling this case. I have no expectation of receiving, nor will I
accept, any other compensation. I accept the above requested fees as the full and complete payment for services
rendered to date in this case. VERIFICATION UNDER MCR 2.114: I declare that the statements above are true to the best of my
information, knowledge, and belief.
Signature of Attorney
FORWARD BILLING TO:
Rev. 2/3/09
Date
OFFICE OF THE JUDICIAL AIDE
MACOMB COUNTY COURT BUILDING
TH
40 N. MAIN, 5 FLOOR
MOUNT CLEMENS, MI 48043
Request for Payment of Court Appointed Attorney FeesJuvenile Consent Calendar Hearings
American LegalNet, Inc.
www.FormsWorkFlow.com
