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Statement Of Services And Order For Payment Of Court Appointed Attorney Or GAL Or Independent Evaluation PEMH 1092 - Michigan
| Statement Of Services And Order For Payment Of Court Appointed Attorney Or GAL Or Independent Evaluation Form. This is a Michigan form and can be used in Criminal Oakland Local County . |
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STATE OF MICHIGAN JUDICIAL CIRCUIT OAKLAND COUNTY PROBATE STATEMENT OF SERVICES AND ORDER FOR PAYMENT OF COURT APPOINTED ATTORNEY, GAL OR INDEPENDENT EVALUATION CASE NO. In the matter of Attorney/Independent Evaluator Name Address City, State, Zip Phone # Vendor ID Appointment Date P# I was appointed to serve as attorney GAL or This is a complete and accurate record of the services I rendered. Estates Division Deceased Estate with no funds Minor/Adult Conservatorship with no funds in Estate Minor/Adult Guardianship Minor/Adult Report Other : Mental Health Division Developmentally Disabled Individual Commitment or Assisted Outpatient Treatment Petition Hearing Jury Trial Deferral Forensic Hearing Ypsilanti Adjourned Hearing Independent Evaluation requested at time of hearing. When Not notified prior to hearing date Demand for Hearing Discharged Other: Other Estates and Mental Health Division evaluator for Name CODE DEC MIC/ADC MIG/LIP REP Fee Per Case $180 $180 $180 $100 Fee Per Case $300 $180 $250 $90 $200 $50 $45 $45 $180 $180 $ Per Hour $75 $75 $60 $60 Hearing Date(s) - not applicable - CODE DDP HOS JUR DEF FOR MIS ADJ ADJ DEM DIS Hearing Date(s) # Of Hours Total Independent Evaluations by Physicians or Mental Health Professionals - - - - - - - ($300 max.) Court Testimony by Independent Evaluator Extraordinary Fees (PLEASE PROVIDE AN ITEMIZED EXPLANATION) Appeals - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ($500 max.) Excess Travel 50 to 74 Miles $25.00 75 to 99 Miles $37.50 100 + Miles $50.00 I declare that the above statements are true to the best of my information, knowledge, and belief. Date Attorney/Independent Evaluator Signature ORDER IT IS ORDERED: The above named attorney/independent evaluator has rendered this service and shall be paid (less any applicable Federal or State court ordered and/or statutory lien, levy or garnishment) dollars from the County Treasurer. Date Please Return to: ATTORNEYS: OFFICE OF THE COURT ADMINISTRATOR OAKLAND COUNTY CIRCUIT COURT 1200 N. TELEGRAPH ROAD, DEPT. 404 PONTIAC, MI 48341-0404 Fax: (248) 975-9877 Circuit/Probate Judge INDEPENDENT EVALUATOR: OAKLAND COUNTY PROBATE COURT 1200 N. TELEGRAPH RD., DEPT 457 PONTIAC, MI 48341-0457 ATTN: KIT SCHATZ (MENTALLY ILL MATTERS) OR Questions? Call Debbie Thompson (248) 858-0255 ATTN: PAT HAYS (GUARDIANSHIP OR CONSERVATORSHIP) ORI MI-630013J American LegalNet, Inc. www.FormsWorkflow.com PEMH 1092 (02/06) STATEMENT OF SERVICES AND ORDER FOR PAYMENT OF COURT APPOINTED ATTORNEY, GAL OR INDEPENDENT EVALUATION - PROBATE
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