Itemized Fee Statement
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2IN THE COMMON PLEAS COURT OF SHELBY COUNTY, OHIO
PROBATE DIVISION
IN THE MATTER OF:
*
CASE NO.__________________
_______________________________
*
*
MOTION, ENTRY AND CERTIFICATION
In Re:__________________________
FOR COUNSEL FEES and/or GUARDIAN
(Party Represented)
*
FEES FOR INDIGENT INDIVIDUAL
* * * * * * * * * * * * * * * * * *
The undersigned moves this Court for an Order approving payment of fees as indicated in the itemized statement herein. I
certify that I have received no compensation in connection with providing representation in this case, or for Guardian services,
other than that described in this motion, or which has been approved by the Court in a previous motion, nor have any fees in
this motion been duplicated on any other motion. I, or an attorney under my supervision, have performed all legal services
and/or guardian services itemized in this motion. I certify that the fees set forth on this statement are reasonable, and are in
accordance with the Local Rules of Shelby County Probate Court (Local Rules 8.1, 71.2, 73.1).
Counsel
Guardian
NOT appointed but serving as counsel for a Guardian of an
I was court appointed as
indigent ward on/beginning ________________, 20____.
If applicable: This case terminated and/or was disposed on
_______________________, 20____. I am submitting this application on _____________________, 20____.
Name______________________________________________ Signature___________________________________________
Address_______________________________________________________________________________________________
Atty Reg. No.__________________.
COURT APPOINTED COUNSEL FEE
Maximum permitted: $400.00 first year and $300.00 annually thereafter
Fee application must be filed preceding to or simultaneous with an Account (if Account is required)
Time period covered: __________ to __________ (maximum time period is two years)
Total Hours __________ x Rate $75.00/hr. = $___________
Total Fee $________
NON-COURT APPOINTED COUNSEL FEE (not court appointed but serving as Attorney for a Guardian of an
indigent ward)
Maximum permitted: $400.00 first year and $300.00 annually thereafter
Fee application must be filed preceding to or simultaneous with an Account (if Account is required)
Time period covered: __________ to __________ (maximum time period is two years)
Total Hours __________ x Rate $75.00/hr. = $___________
Total Fee $________
GUARDIAN FEE (for an ATTORNEY serving as Guardian for an indigent ward)
Maximum permitted: $300.00 annually
Fee application must be filed preceding to or simultaneous with an Account (if Account is required)
Time period covered: __________ to __________ (maximum time period is two years)
Total Hours __________ x Rate $50.00/hr. = $___________
Total Fee $________
GUARDIAN FEE (for LAY PERSON serving as Guardian for an indigent ward)
Maximum permitted: $200.00 annually
Fee application must be filed preceding to or simultaneous with an Account (if Account is required)
Time period covered: __________ to __________ (maximum time period is two years)
Total Hours __________ x Rate $25.00/hr. = $___________
Total Fee $________
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