STATE OF NEW MEXICO COUNTY OF BERNALILLO SECOND JUDICIAL DISTRICT COURT TO: Center for Self Help & Dispute Resolution Arbitration Paralegal Second Judicial District Court PO Box 488 Albuquerque, New Mexico 87103 RE: D-202-CV-: HON. vs. ARBITRATOR'S COMPENSATION REQUEST/WAIVER Initial appropriate paragraph: Pursuant to local rule, I request compensation of $100 for my services as a Court-appointed arbitrator in the above-referenced case, to be mailed to the address below. See W-9 requirement below. I waive compensation authorized by local rule for my services as a Court-appointed arbitrator in the above-referenced case. Optional, collected for statistical purposes. I spent hours providing notice, reviewing the file and other preparation; hours in motions hearings and other pre-trial hearings; hours in hearings on the merits or trial; hours making my decision and preparing the award; = TOTAL HOURS on the case. I held a total of hearings. My usual hourly rate is . Signature: SIGNATURE NAME FIRM ADDRESS PHONE Please note: If this the first time you have billed the Court for services of any kind, you also will need to complete an IRS Form W-9 before the Court can begin to process this request for compensation. The W-9 form can be found on our website at http://seconddistrictcourt.nmcourts.gov, or call (505) 841-6702, and we will provide you with the form. FOR COURT USE ONLY Eligibility to claim fee certified by: American LegalNet, Inc. www.FormsWorkFlow.com