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Mediator Bill For Services NHJB-2630-DOMA - New Hampshire

Mediator Bill For Services Form. This is a New Hampshire form and can be used in Mediation District Division Statewide .
 Fillable pdf Last Modified 4/20/2011
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THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) MEDIATOR BILL FOR SERVICES 1. Name of payee Address of payee Vendor number 2. 3. (If unknown, leave blank & AOC Accounting will complete.) Date of Mediation Type of Case: Mediator Name (if different from payee) Small Claim Civil Writ $60.00 fee $175.00 fee I represent that the foregoing is a true and reasonable bill for the services I rendered. I certify that I have not and will not receive any other compensation for the services specified. Date Mediator Signature Mediator Name (please print) I hereby certify that I have examined the above statement and find the charge to be reasonable. Date Presiding Judge Signature IMPORTANT REQUIREMENTS for filing statement with court Bill for services must be submitted to the court within 30 days of mediating the case. A separate form is required for each case mediated. FOR COURT USE ONLY: CASE TYPE: COURT CODE: NHJB-2630-DOMA (01/01/2010) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com
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