Notice Of Limited Appearance Form L Page 2
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24. By signing this form, or a subsequent Certificate of Acknowledgment of Limited Appearance, the
client agrees that the attorney may withdraw at the completion of the stated representation.
5. The attorney named above is counsel of record and available for service of documents only for those
specifically checked above. For all other matters, the client may be served directly at the following
address:
Client Name:
_______________________________________________
Address:
_______________________________________________
City, State, ZIP: _______________________________________________
6. Attorney contact information:
Attorney Name: _______________________________________________
Address:
_______________________________________________
City, State, ZIP: _______________________________________________
Telephone:
_______________________________________________
Facsimile:
_______________________________________________
E-mail:
_______________________________________________
CERTIFICATION OF ATTORNEY & CLIENT
The undersigned certify that this form sets forth the limited scope of representation agreed to between the
undersigned attorney and client. If the client is not available to sigh this agreement at the time of filing, a
copy bearing his/her signature shall be filed within ten days of the initial filing of this notice.
________________________________
_____________________
CLIENT SIGNATURE
DATE
________________________________
_____________________
ATTORNEY SIGNATURE
DATE
CERTIFICATION OF SERVICE
I certify that a copy of this notice has been duly served on all counsel of record and/or self-represented
parties via facsimile, e-mail, hand delivery, and/or by placing a copy of the same in the United States
Mail, postage prepaid on __________________________________________.
________________________________
_____________________
ATTORNEY SIGNATURE
DATE
THE FAMILY COURT
FORM L, p. 2 of 2
REVISED: NOV 2013
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