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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.
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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
.
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www.USCourtForms.com
STATEMENT OF SERVICE AND ORDER FOR PAYMENT OF COURT APPOINTED REPRESENTATIVE
