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Attorneys Statement Regarding Fees - Ohio
| Attorneys Statement Regarding Fees Form. This is a Ohio form and can be used in Victim Services Attorney General Office Statewide . |
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IN RE: ________________________________________________ CLAIM NO: ___________________ APPLICANT: __________________________________________________________________________ ATTORNEY'S STATEMENT REGARDING FEES I, __________________________________, attorney for the Applicant in the above claim, state under the sanctions of Civil Rule 11 and the penalties of perjury and falsification that: (1) I have not received or contracted for any payment of attorney fees or any fee from my client with respect to this reparations claim; (2) The Itemized Statement of Legal Services filed herewith is an accurate account of the legal services actually rendered; (3) I have read R.C. 2743.65(A) and R.C. 2743.71(B)(3). R.C. 2743.71(B)(3): "An attorney who represents an applicant for an award of reparations cannot charge the applicant for the services rendered in relation to that representation but is required to apply to the Attorney General for payment for the representation;" (Emphasis added.) ______________________________________________ ATTORNEY'S SIGNATURE ______________________________________________ ATTORNEY'S NAME _____________________________________ DATE _____________________________________ ATTORNEY'S REGISTRATION NUMBER REQUIRED PAYMENT INFORMATION The warrant in payment of attorney fees will be made payable to the payee, as you direct below, either to your or to your law firm. The payment will be reported to the IRS as income to the name payee. IMPORTANT: The PAYEE and SSN/Tax I.D. number listed below must be the same as listed on IRS Form #-9. _________________________________________________ PAYEE (Attorney or Attorney's firm) _______________________________ Payee SSN/Tax I.D. ______________________________________________________________________________________ Payee Address American LegalNet, Inc. www.FormsWorkflow.com
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