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Statement Of Service And Order For Payment Of Court Appointed Representative Form. This is a Michigan form and can be use in Criminal Statewide.
Tags: Statement Of Service And Order For Payment Of Court Appointed Representative, MC 221, Michigan Statewide, Criminal
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : PROBATE OSM CODE: ASE Index No. Original - Court Approved, SCAO 1st copy - Attorney : STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY PROBATE ORI STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF : Plaintiff(s) COURT APPOINTED REPRESENTATIVE -against- JUDICIAL SUBPOENA : Court address MI- Calendar No. CASE NO. Court telephone no. : Defendant's/Respondent's name, address, and telephone no. The State of Michigan THE PEOPLE OF : v Defendant(s) : ...................................................... CTN Juvenile Probate SID DOB In the matter of THE PEOPLE OF THE STATE OF NEW YORK STATEMENT OF SERVICE TO 1. I, , was appointed by the court to serve as the Name (type or print) Specify attorney, lawyer-guardian ad litem, etc. GREETINGS: for , and services have been rendered. Name (type or print) 2. Compensation from any other source is not being sought. 3. Dates and the nature of services rendered and expenses areand follows: being laid aside, you and each of you attend before WE COMMAND YOU, that all business as excuses the Honorable DATECounty of SERVICE/EXPENSElocated at TIME at the DATE Court SERVICE/EXPENSE , TIME in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 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 for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable , one of the Justices of the I declare that the above statements are true to the best of my information, knowledge, and belief. Court in County, day of , 20 Attorney/Guardian ad litem/Lawyer-Guardian ad litem signature Date Bar no. (Attorney must sign above and type name below) Social security no. Address Federal identification no. City, state, zip Telephone no. Attorney(s) for NOTE: If requesting payment for services rendered as a lawyer-guardian ad litem, you must attach Form JC 82, Affidavit of Service Performed by Lawyer-Guardian Ad Litem. ORDER FOR PAYMENT I certify that child(ren) and that the service was rendered. IT IS ORDERED was appointed to represent the named defendant/respondent/ Office and P.O. Address disbursing officer shall pay $ District control unit/County to to compensate him/her for Telephone No.: all time and expense in connection with this case. Name (type or print) Judge Date Check no. in the amount of $ Facsimile No.: E-Mail Address: Mobile Tel. No.: Date MC 221 (9/03) Bar no. issued on . American LegalNet, Inc. www.USCourtForms.com STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF COURT APPOINTED REPRESENTATIVE