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Affirmation Of Services For Privately Paid Law Guardian UCS-881 - New York
| Affirmation Of Services For Privately Paid Law Guardian Form. This is a New York form and can be used in Guardianship And Termination Of Parental Rights Family Court Statewide . |
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AFFIRMATION 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 wa(Choose ones by marking X in box): G contested OR Gnot contested (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 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 3. 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: $ perhour (Attach, as Exhibit B, a copy of the order of appointment fixing hourly rate.) 2 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 reasonab le compensation, plus reimbursement for disbursements, for a total award of: $ .DATED: Signature: Print Name: Address: Phone/FAX: / Email: 2 Compensation,excluding disbursements, is the amountto be entered in item 15 of UCS 875 (Statement of Approval of Compensation). Rev. 11/03 UCS 881 Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com
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