Fillable Payment Information - Family Court Service Fees Form printable pdf download

Payment Information - Family Court Service Fees Form

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PAYMENT INFORMATION

FAMILY COURT SERVICE FEES

MEDIATION (IF PREVIOUSLY REFERRED)

$100 each

EXTENDED MEDIATION

$100 each

STUDY/EVALUATION

$500/$1,000/$1,500/$2,000

BFA (Brief Focused Assessment)

$300/$600/$900/$1,200

If paying by cash, cashier’s check, money order or personal check (made payable to the Dane

County Clerk of Circuit Court) use this form and make payment directly to the Dane County

Clerk of Circuit Courts, Dane County Courthouse, 215 S Hamilton St, Room 1000, Madison, WI

53703-3285, by mail or in person.

Debit and credit card payments (Discover, MasterCard, Visa, American Express) can be paid 24

hours a day by phone (888-604-7888) or online There is an additional

service fee to GovPay which begins at $1.50 and increases to $5.00 for a $200 payment; then

each additional increment of $50 or portion thereof add $1.40. Use Pay Location Code 5479.

Payment for Family Court Services is Court Ordered. Failure to comply will result

in an Order to Appear at a Fee Payment Hearing and a Judgment being entered for the fees.

__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

PAYMENT RECEIPT

Use this form for payment by cash, check or money order to the Clerk of Courts office. Payment

should be made at the earliest possible opportunity to continue your work at FCS. This receipt

will be filed in the Family Court Service office, after validation of payment by the Clerk of Courts

office. If paying by credit or debit card, this form is not needed.

NAME OF PAYER ____________________________________________________________

ADDRESS OF PAYER _________________________________________________________

Number/Street

City/State

Zip

CASE NO__________________ NAME OF OTHER PARENT __________________________

PAYMENT ENCLOSED:

For Clerk of Courts Use

Mediation Fee of $__________due _______________

Rec # _____________

Amt ______________

Study Fee of $_____________ due _______________

Date _____________

BFA Fee of $______________ due _______________

Initial _____________

Rev 1/16

Payment Information - Family Court Service Fees Form

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