American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR COUNTY ) , ) Plaintiff, ) CIVIL CASE NO. ) v. ) STATEMENT FOR ATTORNEY ) FEES, COSTS, AND DISBURSEMENTS ) FOR (PLAINTIFF/DEFENDANT) , ) Defendant. ) The undersigned attorney offers the following facts in support of an award of reasonable and necessary attorney fees, costs, and disbursements: 1. Plaintiff/Defendant is entitled to recover attorney fees, costs, and disbursements pursuant to the following facts, statute or rule: 2. Legal Fees including the number of hours and services provided in this matter by each attorney, clerk, and legal assistant and the hourly rates for each are set forth in detail in Exhibit 1. The total sum of these fees is $ . Exhibit 1 is summarized as follows: Number Name Position Hourly Rate of Hours Fees Page 1 - Form 5.080 226 STATEMENT FOR ATTORNEY FEES, COSTS, AND DISBURSEMENTS FOR G PLAINTIFF G DEFENDANT 226 UTCR 5.080 (Please designate one of the above) (Revised 8-1-08) American LegalNet, Inc. www.FormsWorkFlow.com 3. The specific factors supporting an award and the amount of legal fees pursuant to ORS 20.075 or other statute or rule are set forth in Exhibit 2. 4. Litigation expenses billable directly to the client that are not overhead expenses already reflected in the hourly rate for legal services are set forth in detail in Exhibit 3. The total sum of these costs and disbursements is $ . 5. Costs and disbursements supported by ORCP 68 A(2) or other statute or rule, including the prevailing party fee, are set forth in detail in Exhibit 4. The total sum of these costs and disbursements is $ . 6. In anticipation of efforts that will be spent in postjudgment proceedings, plaintiff/defendant seeks the additional sum of $ as explained more fully in Exhibit 5. 7. In summary, plaintiff/defendant is entitled to an award of reasonable and necessary attorney fees in the sum of $ , litigation expenses in the sum of $ , costs and disbursements in the sum of $ , and postjudgment work in the sum of $ . I hereby declare that the above statement, including the information contained in the exhibits to this statement, is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. Date Signature OSB# (if applicable) Type or print name Page 2 - Form 5.080 226 STATEMENT FOR ATTORNEY FEES, COSTS, AND DISBURSEMENTS FOR G PLAINTIFF G DEFENDANT 226 UTCR 5.080 (Please designate one of the above) (Revised 8-1-08)