Periodic Review Worksheet Fees Charged By Counsel Or Guardian {JD-FM-232}

PERIODIC REVIEW WORKSHEET FEES CHARGED BY COUNSEL OR GUARDIAN AD LITEM JD-FM-232 New 10-14 PA 14-3 as amended by PA 14-207 Name of case (Plaintiff v. Defendant) STATE OF CONNECTICUT Court Use Only SUPERIOR COURT www.jud.ct.gov REVWORK *REVWORK* Docket number Name of counsel or guardian ad litem Date of appointment 1. An order was made on (date) allocated as follows: % Mother % Father % Other (3rd party) stating fees to be paid to counsel/the guardian ad litem are 2. Fees paid to counsel/the guardian ad litem to date: $ $ $ Mother Father Other (3rd party) 3. Fees owed to counsel/the guardian ad litem to date: $ $ $ Mother Father Other (3rd party) . semi-annual; 4. The most recent bill was sent to the parties on (date) 5. The parties are billed on a other: 6. Target date for completion (date) Signed (Counsel/Guardian Ad Litem) monthly; quarterly; (i.e. at court appearances) basis. . Print name Date ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. American LegalNet, Inc. www.FormsWorkFlow.com