Statement Of Services Performed By Attorney
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Statement Of Services Performed By Attorney Form. This is a Michigan form and can be use in Adoption Statewide.
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Tags: Statement Of Services Performed By Attorney, PCA 346, Michigan Statewide, Adoption
Approved, SCAO
JIS CODE: VSL
STATEMENT OF SERVICES
PERFORMED BY ATTORNEY
7-DAY
21-DAY
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
In the matter of adoptee
FILE NO.
DOB:
Full name of child
I am an attorney representing the
petitioner mother.
petitioner father.
mother of adoptee.
father of adoptee.
I state that the following list itemizes the services performed and any fees, compensation, or other thing of value received by
or agreed to be paid to me for, or incidental to, the adoption of the child.
Date
Service Performed
Fee, Compensation, or Other Value
SUBTOTAL from 7-Day Statement of Services Performed by Attorney
TOTAL
I represent a party in this direct placement adoption. I have not requested or received any compensation for the activities
described in MCL 710.54(2).
I declare that this statement has been examined by me and that its contents are true to the best of my information, knowledge, and
belief.
Date
Signature of attorney
Name (print or type)
NOTE: Attach this statement to form PCA 347,
"Petitioner's Verified Accounting"
Address
City, state, zip
Telephone no.
Do not write below this line - For court use only
PCA 346 (9/07)
STATEMENT OF SERVICES PERFORMED BY ATTORNEY
MCL 710.54(7)
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