[Attorney Caption: name, address, zip code, telephone #, ID #] IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ MOTION FOR APPOINTMENT OF COUNSEL FOR CHILD AND NO W, ______________ _____________, _________, c omes Petitioner, who moves this Honorable Court to appoint counsel for ___________________________, the child whose par ent(s)' rights may be involuntarily terminated in the above matter, and deposits against fees in the matter. One Hundred F ifty ($150.00) Dollars ______ ____[Signature]____________ American LegalNet, Inc. www.FormsWorkFlow.com