THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) GUARDIAN AD LITEM STATEMENT NAME AND ADDRESS OF PAYEE: Name Name of GAL if different from Payee Law Firm, if applicable Bar ID # of attorney Federal I.D. Number of Payee Address City State Zip code TYPE OF BILLING: Final Interim Supplemental Total hours X $60/hr = $ ADD EXPENSES $ INVOICE TOTAL $ TOTAL OF PREVIOUS BILLS IN THIS CASE $ I represent that the foregoing is a true and reasonable bill for services rendered and that I have been board certified at all times during my service in this case. Date Signature of Guardian ad Litem ORDER Statement: GRANTED DENIED OTHER: Date Presiding Justice NOTE: Guardians must attach a copy of the order appointing them as Guardian ad Litem. NHJB-4018-Se (07/01/2018) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Case Number: GUARDIAN AD LITEM STATEMENT INSTRUCTIONS DEFINITIONS CASE: For purposes of Guardian ad Litem compensation, a case is defined as all preparation and proceedings for assigned cases. EXPENSES: Expenses which will be paid are mileage at the state rate per mile and telephone. Any additional expenses must be documented by receipts which accompany the statement. No overhead expenses (photocopies, postage, or secretarial services) will be paid. FINAL BILL: A final bill is a bill submitted at case disposition. INTERIM BILL: An interim bill is a bill submitted before a case is concluded. SUPPLEMENTAL BILL: A supplemental bill is a bill for services after a final decree of divorce, parenting, legal separation, or civil union dissolution has been issued. MAXIMUM COMPENSATION Time spent shall be compensated at $60.00 per hour. Only with prior approval of the presiding judge and when all parties are notified and upon an express, written finding of good cause and exceptional circumstances by the court will the maximum fee be exceeded. Maximum fee for marital/parenting cases: $ established by the Court in this case. Maximum fee for abuse / neglect cases through conclusion of dispositional hearing: $1,400. Maximum fee for CHINS or Delinquency cases through conclusion: $900. Maximum fee for court review hearings in guardianship or abuse / neglect cases: $300. Maximum fee for TPR cases: $1,400. Maximum fee for appeals to the superior court: $900. Maximum fee for guardianship of minor cases: $1,400. The Guardian ad Litem shall not incur expenses in excess of the maximum fee without prior approval of the Marital Master or Judge and notice to all parties. The Guardian ad Litem must have been a board certified GAL at the time services were rendered to bill for those services. All bills must be itemized as to the time spent on each case and there shall be no separate charge for overhead. When the Guardian ad Litem expends time in court for more than one case on any particular day, the hours spent in court shall be allocated accordingly. For services other than those of the Guardian ad Litem, the Guardian ad Litem shall seek prior approval of the Marital Master or Judge. SUBMISSION OF STATEMENT A final bill should be submitted within sixty (60) days from the date a case is disposed of or when the Guardian ad Litem has been discharged. NHJB-4018-Se (07/01/2018) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com