Attorney Fee Response Form {10681}

For Office Use Only File Number Office of Attorney Ethics Date Entered in OAE Database Filing Fee Paid: Yes Date Response Received No Attorney Fee Response Form A Non-Refundable Filing Fee check in the amount of $50 must be included payable to "Disciplinary Oversight Committee." Please type or clearly print all information: Submit 1 original and 5 copies of all documents submitted, including attachments. Attorney's Name: Client's Name: 1. What was the total amount of the attorney's bill? Total Legal Fee $ + Total Costs and Disbursements $ = Total Bill $ Amount previously paid to you on the client's behalf: $ 2. (a) Type of Case: (b) Date representation commenced: (c) Date services completed or representation terminated: 3. (attach proof of payment) Was there a written fee agreement or fee letter sent to the client explaining how much would be charged? (a) If yes, attach a copy. (b) If no, had you or the law firm regularly represented the client before? (c) If no, what arrangement for legal fees was agreed upon, and when? Yes No Yes No (d) Was this a contingency case? 4. Yes No (a) Briefly, what was the fee arrangement? (b) What was the initial fee quoted to the client? $ (c) What was the final bill? $ 5. If the final bill [4(c)] is different than the initial fee quoted [4(b)], state the reason, the date the client was advised of the change, and attach copies of any retainer or agreement authorizing such change, and any documents advising the client of the change. Revised: 08/2013, CN: 10296 page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Attorney Fee Response Form 6. Was one or more itemized bills submitted to the client? Dates bills were provided to client: Yes No 7. 8. If client made payments on bill, attach itemized list showing date(s) received and amounts. Did you maintain time records in this case? If not, why not? Yes No (If yes, attach copies) 9. Have you brought a lawsuit for your fees, or are the fees at issue in any court proceeding? (If yes, attach a copy of the complaint or court filing) (a) If yes, state the date of service of process on client: (b) Did you give pre-action notice to client under R. 1:20A-6? (If yes, attach a copy) Yes Date: Yes No No 10. State your response to the client's answer to section "I" of the Attorney Fee Arbitration Request Form, which explains why the client disagrees with your bill: 11. Do you assert that another attorney or law firm may be responsible for or entitled to any part of the fee? If so, state the correct names below and serve them in accordance with R. 1:20A-3(b). Name: Firm: Mailing Address: Telephone: Yes No Attorney Certification I hereby certify that all of the foregoing statements made by me are true, and that all documents attached are true copies of the originals, and that I have, contemporaneously with filing this form with the secretary of the district fee arbitration committee, mailed a copy by certified mail to the client, with return receipt requested and that I have also completed service on any other attorney or law firm listed in question 11, above. I am aware that if any part of this Response Form is willfully false, I am subject to punishment. Dated: Signed: (Please Print Name Below Signature) Please Notify District Secretary of Disability Accommodation Needs. Revised: 08/2013, CN: 10296 page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com