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Arbitrators Fee Statement L190 - California
| Arbitrators Fee Statement Form. This is a California form and can be used in Civil Orange Local County . |
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Arbitrator Name and Address: Telephone No.: E-Mail Address (Optional): Fax No. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Civil Complex Center - 751 W. Santa Ana Blvd., Santa Ana, CA 92701-4512 Harbor-Laguna Hills Facility 23141 Moulton Pkwy., Laguna Hills, CA 92653-1251 Harbor Newport Beach Facility 4601 Jamboree Rd., Newport Beach, CA 92660-2595 North 1275 N. Berkeley Ave., P.O. Box 5000, Fullerton, CA 92838-0500 th West 8141 13 Street, Westminster, CA 92683-0500 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: ARBITRATOR'S FEE STATEMENT CASE NUMBER: Pursuant to California Rules of Court, rule 3.819 and Local Rules - Superior Court of California, County of Orange, rule 360, the following fee(s) are requested for conducting arbitration proceedings in the above-named case. (Attach a declaration to support payment of fees if the case settled at the hearing, no hearing was conducted or extraordinary fees are requested.) Date session concluded: Name of Arbitrator: Name of Payee: Address of Payee: Date Award or Settlement filed with the Court: Fee(s) Requested Fee for entire session: Extraordinary fees: TOTAL: $ 150.00 Last four digits of your Social Security # or your full Taxpayer Identification #: A current signed IRS Form W-9 or Payee Data Records is: attached has been submitted to the Court I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Arbitrator: (For Clerk's Use Only) ALAN CARLSON, Clerk of the Court Amount approved: $ By: Authorization __________________________________________ (For Accounting Services Use Only) Account Coding G/L Acct. 939102 Cost/Fund Center 306311 WBS Element Functional Area PCT 1220 Fund 110001 Accounting Services Approval Date: Authorized By: Tax Code Amount Deputy Clerk Review and Authorization Date: By: ARBITRATOR'S FEE STATEMENT Approved for Optional Use L-0190 (Rev. August 2009) California Rules of Court, rule 3.819 American LegalNet, Inc. www.FormsWorkFlow.com
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