Form Fm-1067 - Application For Payment Of Attorney Fees And Costs Of Children'S Counsel
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1
2ATTACHMENT FM-1067
ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name and Address):
TELEPHONE NUMBER:
FOR COURT USE ONLY
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS:
201 North First Street, San José, CA 95113
MAILING ADDRESS:
191 North First Street
CITY AND ZIP CODE:
San José, California 95113
BRANCH NAME:
Family Justice Center
PETITIONER:
RESPONDENT:
CLAIMANT:
CASE NUMBER:
APPLICATION #:
APJ:
APPLICATION FOR PAYMENT OF ATTORNEY FEES AND
COSTS OF CHILDREN’S COUNSEL
DEPARTMENT:
I,
, declare the following:
1. I am the Child(ren)’s Counsel in the above-entitled action. I was appointed on
,
by the Honorable
to represent the following child(ren) in this
matter:
.
2. I, and/or my staff, have completed
hours of work on this matter between the date
of and
.
3. At my billing rate of $
per hour, I have billed a total in fees and costs of $
during this
time period. Billing is at a reduced rate of $
per hour. My usual hourly rate is $
per hour.
4.
This matter, as it pertains to my client(s), is complete.
An order has been entered, or
I am currently requesting that an order be entered for that reason, terminating my appointment.
5. I am now requesting attorney fees and costs from
through
for the
hours that I and/or my staff have spent on behalf of the minor child(ren)
since my appointment, or
since my last application for an order for fees.
6.
I am now requesting that the court order the replenishment of the retainer. I ask that each party pay the
amount of $
to me within fifteen (15) days of the date the Order for Fees is filed.
FM-1067 REV 08/01/16
Page 1 of 2
APPLICATION FOR PAYMENT OF ATTORNEY FEES AND
COSTS OF CHILDREN’S COUNSEL
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