SUPERIOR COURT OF ARBITRATORS REQUEST WASHINGTON FOR COMPENSATION COUNTY OF SPOKANE PLAINTIFF: ____________________________ CASE NO. ________________________ vs. DEFENDANT: ____________________________ This case was resolved by settlement nd the arbitration settlea me ntand order of removal from the trial calendar has been filed with the clerk of the court. This case was resolved by award and the arbitration award has be filed with the clerk of the court. en The Arbitrator to this case devoted the following dates/time: Date Hours Purpose TOTAL (If additional spaces are needed please use page two) HOURS Send completed forms to Arbitration Department, W. 1116 Broadway, Spokane, WA 99260-0350 The undersigned certifies that she/he was duly appointed and served as an arbitrator in this case for the dates/time stated above. Make Check Payable To: FOR OFFICE USE ONLY Name or Firm: _______________________________________ Charge to County: $ TOTAL Signature: Charge to State: $ $ Typed Name: Payment Approved by: Address: ___________________________________ Director of Arbitration Date City: Zip: Social Security or Tax Identification No.:_____________________ (Number used for reporting compensation to IRS) A TTORNEY AT LAW RETIRED JUDGE FOR STATE USE ONLY Doc. Date Payment Current Doc Ref. Doc. No Vendor No. Vendor Message Due Date No. Ref M Sub Doc Trans O Fund Appn Program Sub Sub Org Alloc Budget Mos Project Sub Proj Amount Invoice Suf Code D Index Index Obj Obj Index Unit Proj Phas Number >>>> 2 ARBITRATORS REQUEST FOR COMPENSATION PAGE TWO The Arbitrator to this case devoted the following dates/time: Date Hours Purpose HOURS PG 2 HOURS PG 1 TOTAL HOURS Attach this page to Arbitrators Request For Compensation form.