30-12 () REQUEST FOR FEE REVIEW IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH 1021 SW 4TH AVENUE, PORTLAND OR 97204 Case No. Plaintiff/Petitioner REQUEST FOR FEE REVIEW vs. Defendant/Respondent Pursuant to SLR 13.120, the arbitrator has determined that the case require extraordinary effort and time. The parties have not agreed to the requested fees. The arbitrator hereby requests review of the arbitration fees. Amount Requested $ (If either party had a fee waiver or deferral, the hearing must be billed at the commission approved rate.) Reason for request: Certification I hereby certify that the above information is accurate and that I have sent copies of this notice to all parties/attorneys of record. Date Arbitrator American LegalNet, Inc. www.FormsWorkFlow.com