STATE OF NEW YORK FAMILY COURT, COUNTY , Petitioner, AFFIDAVIT -V- DOCKET NO: , Respondent. , ESQ., being duly sworn deposes and says: LAW GUARDIAN 1. I am an attorney licensed to practice law in the State of New York with an office at , , New York . I was appointed law guardian by Honorable in the above captioned matter on , 20 . 2. The fees of deponent in the above captioned matter are in excess of the statutory limit because of unusual and extraordinary circumstances. 3. Deponent represented one child on a petition to modify a prior order of custody. 4. Deponent expended significant in-court time on this matter. A full trial was held over the course of three days. 5. Deponent expended significant out-of-court time on this matter because: __________________________________________________________ A) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________. B) __________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 1 American LegalNet, Inc. www.USCourtForms.com ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________. C) __________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________. 6. Deponent believes that the time expended was necessary and proper to the representation of the child and was not excessive in light of the extraordinary circumstances of the case. WHEREFORE, deponent prays that fees and disbursements incurred as reflected by the attached voucher dated , 20 , be approved and certified by Family Court, County. Law Guardian Subscribed and sworn to before me this _____ day of ____________, 20___ Notary Public 2 American LegalNet, Inc. www.USCourtForms.com