SUPREME COURT, APPELLATE DIVISION THIRD JUDICIAL DEPARTMENT OFFICE OF ATTORNEYS FOR CHILDREN 286 Washington Avenue Extension Suite 202 ALBANY, NY 12203 Phone (518) 471-4825 FAX (518) 471-4757 E-mail: ad3oac@nycourts.gov EXPERT SERVICES AND REPRESENTATION EXPENSE PRE-APPROVAL FORM Date:_________________________ Children's Attorney _____________________________________________________________ Address _____________________________________________________________________ Zip:____________ City _____________________________________ State: _________ Telephone _____________________________ Client Surname___________________________ Fax_________________________________ Proceeding Type______________________ Service Provider ________________________________________________________________ Address ______________________________________________________________________ City _____________________________________ State: _________ Zip:____________ Services to be Performed_________________________________________________________ _____________________________________________________________________________ Explain Need for Services________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ Hourly Rate____________________________ Total Maximum Cost____________________ Allocation of Cost for Child's Share ________________ Approved: _________________________________ Supreme/Family/Surrogate Court Judge _________________County ______________________________________ Director, Office of Attorneys for Children Third Judicial Department Date:_____________________________ rev.1-12-15 Date________________________________ American LegalNet, Inc. www.FormsWorkFlow.com