IN THE FAMILY COURT OF In Re: The Marriage of In Re: The Children of Domestic Violence Protective Order Proceeding COUNTY, WEST VIRGINIA Civil Action No.: and Petitioner (First/Middle/Last) Respondent (First/Middle/Last) Address Phone Number Address Phone Number ORDER RECOMMENDING PAYMENT BY SUPREME COURT: APPOINTED GUARDIAN AD LITEM On a former date, this Court appointed , a licensed attorney at law, to serve as a Guardian Ad Litem in the above-styled case and report to the Court of his or her findings. The attorney has informed the Court that the proceedings have been completed, and has tendered an invoice form FCOGINV (previously form SCA-F-405) setting forth the services performed and an itemized statement of the allowable expenses incurred in connection with the above-styled case. The Court has inspected the invoice and accompanying documentation, found the fees to be reasonable, and charged at a rate of eighty dollars ($80.00) per hour for out-of-court services and one-hundred dollars ($100.00) per hour for in-court services. The Court also finds that mileage expenses, if included, are allowable and charged at the approved state rate. Furthermore, the Court finds that the invoice contains no charges for reimbursement of office expenses. The Court hereby recommends payment in the amount of $ ( does does not exceed fees of $3,000.00) to the Guardian Ad Litem in accordance with Rule 47 of the Rules of Practice and Procedure for Family Court and/or Rule 26 of the Rules of Practice and Procedure for Domestic Violence Civil Proceedings which refers to Rule 21 of the West Virginia Trial Court Rules. Where a Guardian Ad Litem was appointed for an infant child or children of a party or parties, the Court finds that a party has, or both parties have, filed Fee Waivers with the Circuit Clerk, therefore meeting eligibility requirements specified by the Administrative Director of the Supreme Court of Appeals. Where a Guardian Ad Litem was appointed for a party infant, the Court finds that the infant has a Fee Waiver filed with the Circuit Clerk, therefore meeting eligibility requirements specified by the Administrative Director of the Supreme Court of Appeals. Where a Guardian Ad Litem was appointed for an adult who is: incarcerated, incompetent, committed to a mental health facility and/or active military personnel, the Court finds the party filed a Fee Waiver with the Circuit Clerk, therefore meeting eligibility requirements specified by the Administrative Director of the Supreme Court of Appeals. Check Payable To: Remit To Mailing Address: ENTER: ______________________________________________ Family Court Judge American LegalNet, Inc. www.FormsWorkFlow.com OR OR FCOAGSC Rev. 07/2012 (previously SCA-F-403) Order Approving Payment By Supreme Court: Appointed Guardian Ad Litem Page 1 of 1