INSTRUCTIONS < Attorneys who are replaced by a retained attorney, without notice, at the district court must complete the Retained Out Verification Notice in order to receive payment. Attorneys must present the completed Retained Out Verification Notice and submit it to a district court clerk for verification. The clerk will sign and date the form. (It is expected that the form will be submitted to the district court clerk for verification on the date of the scheduled court appearance.) Attorneys must present the verified Retained Out Verification Notice, along with their voucher to the Circuit Court Administrator's Office for payment. Effective January 1, 2003, retained out fees will not be paid without a verified Retained Out Verification Notice. < < < RETAINED OUT VERIFICATION NOTICE Attorney Name ____________________________________ P __________________ Date _________________________ Prosecutor Order Number __________________ Case Name ___________________________________________________________ This notice verifies that the above named attorney appeared for a scheduled court date at the ____________ District Court and was retained out without notice. Date: _________________________ __________________________________ District Court Clerk (signature) Revised 06/2004 American LegalNet, Inc. www.USCourtForms.com