NHJB-2756-DFPS (08/17/2012) 1. This Motion to Exceed Fee Cap pertains to the case type below: a) Motion to Exceed Counsel fee cap of $1,700 in the above case: Termination of Parental Rights Abuse/Neglect Delinquency CHINS b) Motion to Exceed Counsel fee cap of $900 in the above case: Guardianship (464-A) c) Motion to Exceed Guardian Ad Litem fee cap of $1,400 in the above case: Termination of Parental Rights Abuse/Neglect Guardianship (463 or 464-A) d) Motion to Exceed Guardian Ad Litem fee cap of $900.00 in the above case: Delinquency CHINS e) Motion to Exceed Counsel fee cap of $1,400 in this de novo juvenile appeal to Superior Court. f) Motion to Exceed Guardian Ad Litem fee cap of $900 in this de novo juvenile appeal to Superior Court. g) Motion to Exceed Counsel fee cap of $600 in the above case: Involuntary Admissions 2. Rules 48 and 48-A require that, prior to an order allowing the fee guidelines to be exceeded, there must be a finding that good cause and exceptional circumstances justify the order. Please state the facts upon which you rely to demonstrate that this requirement has been met. (attach additional pages if necessary): 3. I have not exceeded the fee cap before the filing of this Motion. 4. I have attached the original Order of Appointment. 5. I have attached the original petition(s). 6 I am requesting approval to exceed the fee cap by an additional amount of $ in anticipation of future bills. (Attach copy of most recent bill) 7. The total of my bills in this case $ (Attach copies of itemized invoices) I represent that the foregoing is a true and reasonable bill for the services I rendered and for the costs incurred. I certify that I have not and will not receive any other compensation for the services or costs specified on the attached itemization. Date Provider Signature Telephone Address THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH htt p ://www.courts.state.nh.usCourt Name: Case Name: Case Number: (if known) MOTION TO EXCEED COUNSEL OR GUARDIAN AD LITEM FEE CAP American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: REQUEST TO EXCEED COUNSEL OR GUARDIAN AD LITEM FEE CAP NHJB-2756-DFPS (08/17/2012) IMPORTANT REQUIREMENTS for filing statement with court A Motion to Exceed Attorney or Guardian ad Litem Fee Caps must be submitted to the court prior to exceeding the fee cap. The motion must include the following 1. A copy of the order of appointment or order authorizing services, if applicable. 2. Itemization of all charges, including the date, amount of time and rate. 3. Itemization of all expenses, including a description of each expense and the cost of each expense. 4. A copy of the order or notice of decision, if any, granting a motion to exceed the fee cap related to the case. American LegalNet, Inc. www.FormsWorkFlow.com