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Motion For Approval Of Attorneys Fee And Allocation Of Chid Support Arrearage - Florida
| Motion For Approval Of Attorneys Fee And Allocation Of Chid Support Arrearage 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 , ) (Employees name) ) Claimant, ) ) vs. ) OJCC Case No.__________________ ) Judge Assigned:________________ , ) Date of Accident:____/____/____ (Employers name) ) Employer/Carrier. ) _____________________________) MOTION FOR APPROVAL OF ATTORNEYS FEE AND ALLOCATION OF CHILD SUPPORT ARREARAGE FOR SETTLEMENTS UNDER SECTIONS 440.20(11)(c), (d), and (e), FLORIDA STATUTES 1. The parties have reached a settlement agreement arising out of the above-styled industrial accident. 2. Pursuant to the contract of representation, the Claimant has agreed to pay his/her attorney a fee for services rendered in obtaining this settlement. 3. The total amount of the settlement is $__________. The Claimant agrees to pay and counsel agrees to accept the sum of $__________ which is is not within the statutory percentages set forth in Section 440.34, Florida Statutes. The net settlement of the Claimant after fees will be $__________, less any costs which may be payable. 4. The Claimant understands that he/she may request a hearing to determine a reasonable fee to be paid under the circumstances of this case. The Claimant waives his/her right to a hearing on this issue. 5. According to the attached information, there is an outstanding child support arrearage of $__________ [If no arrearage, enter "0"]. The claimant agrees that the sum of $_________ shall be withheld from the settlement proceeds and whether claimants attorney or carrier is paying the child support arrearage from settlement.] WHEREFORE, the Claimant and the undersigned counsel, request entry of an order approving the attorneys fee to be paid from the settlement proceeds and the child support arrearage allocation under this settlement. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 Dated this ____ day of ___________________, 200___. ______________________________ ______________________________ Employee Counsel of Record CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the above motion has been mailed on this ______ day of ___________________, 200____, to counsel of record and to the parties at the address below, if unrepresented. _______________________________ (signature) COPIES FURNISHED: employee employees address of record carrier carriers address of record 2 American LegalNet, Inc. www.USCourtForms.com
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