Order Appointing Law Guardian Page 7
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10AFFIRMATION OF SERVICES
Court:
FOR
PRIVATELY PAID
County:
LAW GUARDIAN
------------------------------------------------------------
X
Title of Action
COMPENSATION FOR PERIOD:
___/___/____ to ___/___/____
Mo Day
Yr
Mo Day Yr
------------------------------------------------------------
INDEX NO. ____________/________
X
No.
Yr.
State of New York
)
) ss:
County of _____________________ )
affirms under penalties of perjury:
Name of Appointee
1. By order of this Court (Hon.____________________), dated ___________________, 20 ,
1
I was appointed Law Guardian for the following child(ren) of the parties :
Name(s) of child(ren):
(11)
2. During my period of service, this action/proceeding was
(Choose one by marking “X” in box):
G
G
contested
not contested
OR
12)
(
1
Text boxes are key-numbered (##) to items on UCS 875 (Statement of Approval of
Compensation).
Rev. 11/03
UCS 881
Page 1 of 2
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