Florida > Workers Comp
Certification Of Counsel For Relief From Paying Costs - Florida
| Certification Of Counsel For Relief From Paying Costs Form. This is a Florida form and can be used in Workers Comp . |
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STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGES OF COMPENSATION CLAIMS , ) (Employee ) ) Claimant, ) ) vs. ) OJCC Case No. ) , Date of Accident: ) (Employer) ) Employer/Carrier. ) ______________________________________) CERTIFICATION OF COUNSEL FOR RELIEF FROM PAYING COSTS OF PREPARATION OF THE RECORD Pursuant to Sections 57.081(1) and 440.25(5), Florida Statutes, and Rule 9.180(g)(3), Florida Rules of Appellate Procedure, the undersigned attorney for __________________ ("Appellant"), certifies that: 1. I have investigated Appellants financial condition and found Appellant to be insolvent. 2. I have not been paid or promised payment of a fee or other remuneration except for the amount, if any, ultimately approved by the judge of compensation claims to be paid by the employer/carrier if such entitlement is determined by the court. 3. The appeal was filed in good faith and the appellate court reasonably could find reversible error in the record. My opinion is based upon the following specific legal and factual grounds [state with particularity]: Respectfully submitted, ___________________________________ American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 (Attorneys Name) (Attorneys Address and Bar No.) Counsel for Appellant American LegalNet, Inc. www.USCourtForms.com
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