Form JH-C1(Rev.2006) BILL OF COSTS JUDICIAL HOSPITALIZATION INSTRUCTIONS: Form JH-C1 must be submitted within 90 days of the final disposition of case. The clerk shall retain one copy and forward the original to the Director of the Administrative Office of the Courts, Nashville City Center, Suite 600, 511 Union Street, Nashville, TN 37219. STATE OF TENNESSEE County of _________________________________ Court ______________________________________ Clerk _____________________________________ IN THE MATTER OF _______________________________________________________________________ Order entered _______ of ____________________________, 20______ Docket # _____________________ Directions: For items 1-3, only one amount should be entered. Choose the correct court and fee and enter the total on the line to which it corresponds. Then enter any amounts applicable under items 4-6. Total the fees at the bottom of the page. 1. T.C.A. § 8-21-401 (b)(2)(C)(3) Clerks of Probate Court, and others The clerks of various courts administering estates, guardianships, conservatorships, and other probate matters are entitled to receive the following fee: For filing a request for letters of guardianship and conservatorship issuing all initial process and cost bond; entering order and issuing certificate of guardianship and conservatorship, not including fee of the sheriff; and including final accounting and order closing, regardless of court where filed …………………………………..... $160.00 ____________________________ 2. T.C.A. § 8-21-401 (b)(2)(C)(5) Clerks of Circuit or Chancery Court For filing requests under the mental health law, compiled in title 33, issuing notices, entering return, and entering judgments after hearing, not including fee of sheriff ………………………………………………………………………………….……$50.00 3. T.C.A. § 8-21-401 (f)(1) Clerks of General Sessions Court ____________________________ Standard filing fee covering all initial court clerk’s costs for initiating a civil proceeding in general sessions court including hearings regarding short term mental health commitments ……………………………………………………….……………….$42.00 ____________________________ 4. T.C.A. § 8-21-901(3)(D) Sheriff Fees Travel expenses- The sheriff shall be entitled to the same mileage allowance when required to transport a prisoner to a hospital or other mental health facility in another county or state for a judicially ordered evaluation. §8-21-901(b) Notwithstanding other provisions of this section to the contrary, any fee or mileage allowance permitted under this section, which is assessed against the state or which otherwise represents a cost to the state, shall be limited in the amount to the fees allowable immediately prior to May 28, 1977. Guards or Sheriff Statement Attached _______ miles @ $.20/mile ________________________ 5. T.C.A. § 8-21-901 Other Sheriff Fees Other-Specify _______________________________________________ ________________________ 6. T.C.A. §24-4-101 Witness Fees _____________________________________________Statement attached ________________________ TOTAL COSTS AUTHORIZED ________________________ American LegalNet, Inc. www.USCourtForms.com