Order Appointing Law Guardian Page 8
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103. The nature of the services provided is evidenced by my time records, attached as Exhibit A,
which itemize and total my charges, plus disbursements, and separately itemize and total all
payments received from each party;
4. Compensation, excluding disbursements, is requested for:
(14)
Number of Hours
a. the hours spent during the current period (see Exhibit A):
b. at the hourly rate of:
$
per hour
(Attach, as Exhibit B, a copy of the order of appointment
fixing hourly rate.)
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c. for total compensation
of:
(15)
Total Compensation
5. I request reimbursement for disbursements in the amount of:
$
.
WHEREFORE, I respectfully request that the Court grant fair and reasonable compensation,
plus reimbursement for disbursements, for a total award of:
$
.
DATED:
Signature:
Print Name:
Address:
Phone/FAX:
/
Email:
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Compensation, excluding disbursements, is the amount to be entered in item 15 of
UCS 875 (Statement of Approval of Compensation).
Rev. 11/03
UCS 881
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