Petition For Fee Arbitration

PETITION FOR RESOLUTION OF FEE DISPUTE Docket No.____________ BEFORE THE WYOMING STATE BAR For Office Use Only Person filing this petition: Attorney you are filing this petition against: Name: Name: Address: Address: City, State, Zip: City, State, Zip: Daytime Telephone: Daytime Telephone: Date of Final Billing: Amount of Dispute: $ According to the Wyoming Supreme Courts rules governing fee disputes, a final billing (1) The first bill submitted by the attorney to a client after the case is closed and after the work to complete the cashas been performt ed for which the attorney was originally hired; or (2) The first bill submitted by the attorney to a client following termination of the attorney-client relationship by either the attorney or the client; or (3) A statement which purports to support a distribution of money or value exchanged arising from a contingency fee case. Please provide the date of that billing and a copy of the last bill you received. If the case was a contingent fee case, please provide the date of the statement of distribution your attorney is required to provide you. A petition may be dismissed if filed 120 days or more after final billing. Are there any other person who may be directly affected by the outcome of this petition? 9 Yes 9 No Is so, please complete the following: Name: Telephone Number: Address: City, State, Zip: Please use the space provided below to explain clearly and brieflythe facts which have led y ou to file this petition. If yare objecting to aou specific portion of your attorneys bill, indicate which portion and state the basis of your objection(s). It is important that you attach copies of billing statements. Please attach copies of billing statements and any other material you feel is relevant. If you need additional space, please continue on the back of this page. I HEREBY AFFIRM that the forgoing recitation of facts is true to the best of my knowledge. I further acknowledge that by filing thispetition for resolution of fee dispute, I have elected to proceed under the Wyoming Supreme Court rules regarding resolution of feedisputes. I understand that the determination of the hearing panel appointed pursuant to these rules is binding. I HEREBYENCLOSE A $25.00 ADMINISTRATIVE FEE made payable to the WYOMING STATE BAR. Dated this ________ day of ______________, 20______. Return this form to: Wyoming State Bar Signature of Complainant___________________________________. P.O. Box 109 Cheyenne, WY 82003-0109 F:\WSB\FORMS\WSB Fee Dispute\Fee Dispute Petition.WPD