STATE OF MICHIGAN JUDICIAL CIRCUIT OAKLAND COUNTY JUVENILE STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF COURT APPOINTED ATTORNEY/GAL CASE NO. In the matter of Attorney name Phone # Address Vender ID City, state, zip Appointment Date The above named attorney was appointed to serve as attorney/GAL for accurate record of service rendered appears on the time sheet below. P# .A complete and Name PHASE FEE PER CASE I $120 I-A $150 Plea or Dismissal Phase (multiple hearings/multiple days) II $300 Trial or Permanent Wardship (testimony taken) III $450 PROCEEDING PHASE Preliminary Phase (Preliminary and Initial/Pretrial hearings) Pretrial/Disposition Phase (one hearing/one day) Each Additional ½ Day of Trial HEARING DATE(S) $125 per ½ day COURT PROCEEDING TYPE CODE NDR PPH DDR PCR MIS ADO PAR SAT MIS APP MIS Neglect Dispositional Review Hearings Permanency Planning Hearings Delinquent Dispositional Review Hearings Permanent Custody Review Hearings Foster Care Review Hearings Adoption Hearings Parental By-Pass Consultations Saturday Preliminary Hearings Motion Appeals (maximum $1000.00 per case) Consent Attorney Other: FEE HEARING DATE(S) OR HOUR(S) $130 per hearing $140 per hearing $60 per hearing $60 per hearing $60 per hearing $125 per ½ day $125 per case $125 per ½ day $60 per hour $60 per hour $125 per ½ day Extraordinary Fees PLEASE PROVIDE AN ITEMIZED EXPANATION. Rate is $60 per hour. As it relates to child protective cases, I have consulted with the child’s parents and/or guardians, foster care providers and caseworkers. In addition, I have met with and observed the child before every proceeding or hearing and/or reviewed the agency case file. I declare that the above statements are true to the best of my information, knowledge, and belief. Date Attorney Signature ORDER IT IS ORDERED: The above named attorney rendered this service, filed a payment voucher, and shall be paid (less any applicable Federal or State court–ordered and/or statutory lien, levy or garnishment) dollars from the County Treasurer. Date Please Return to: Circuit/Probate Judge OFFICE OF THE COURT ADMINISTRATOR OAKLAND COUNTY CIRCUIT COURT 1200 N. TELEGRAPH ROAD, DEPT 404 PONTIAC, MI 48324-0404 Questions? Call Debbie Thompson (248) 858-0255 Fax: (248) 975-9877 CCFJ 1000 (10//08) STATEMENT OF SERVICE ANDORDER FOR PAYMENT OF COURT APPOINTED ATTORNEY/GAL ORI MI-630013J American LegalNet, Inc. www.FormsWorkflow.com