Fillable ATTACHMENT FM-1067 201 North First Street, San Jos, (The Superior Court of California, County of Santa Clara)

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ATTACHMENT FM-1067 201 North First Street, San Jos, (The Superior Court of California, County of Santa Clara)

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ATTACHMENT FM-1067
ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name and Address): TELEPHONE NUMBER:
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CO
DE:
BRANCH NAME:
201 North First Street, San José, CA 95113
191 North First Street
San José, California 95113
Family Justice Center
PETITIONER:
RESPONDENT:
CLAIMANT:
CASE NUMBER:
APPLICATION #:
APPLICATION FOR PAYMENT OF ATTORNEY FEES AND
COSTS OF CHILDREN’S COUNSEL
APJ:
DEPARTMENT:
I, , declare the following:
1. I am the Child(ren)’s Counsel in the above-entitled action. I was appointed on ,
by the Honorable to represent the following child(ren) in this
matter: .
2. I, and/or my staff, have completed hours of work on this matter between the date
of and .
3. At my billing rate of $ per hour, I have billed a total in fees and costs of $ during this
time period. Billing is at a reduced rate of $ per hour. My usual hourly rate is $ per hour.
4. This matter, as it pertains to my client(s), is complete.
An order has been entered, or
I am currently requesting that an order be entered for that reason, terminating my appointment.
5. I am now requesting attorney fees and costs from through
for the hours that I and/or my staff have spent on behalf of the minor child(ren)
since my appointment, or since my last application for an order for fees.
6. I am now requesting that the court order the replenishment of the retainer. I ask that each party pay the
amount of $ to me within fifteen (15) days of the date the Order for Fees is filed.
FM-1067 REV 08/01/16
APPLICATION FOR PAYMENT OF ATTORNEY FEES AND
COSTS OF CHILDREN’S COUNSEL
Page 1 of 2
ATTACHMENT FM-1067
PETITIONER:
RESPONDENT:
CASE NUMBER:
7. Each month since my appointment I have sent billing statements to the parties through their attorneys of
record, or, if self-represented, to the party directly. I am submitting with this application, copies of those
statements as Exhibit “A,” not to be filed in the court file. My time was billed at the rate of $
per hour. If applicable, I have billed paralegal time at the rate of $ per hour. I have
recorded hours at no charge.
8. I am requesting fees in the amount of and costs in the amount of . I recommend that the
court allocate the payment of such fees and costs as follows:
% to be paid by Mother;
% to be paid by Father;
% to be paid by the Superior Court
for the following reason(s):
9. I mailed a copy of this Application and Exhibits with a blank Response and blank Income and Expense
Declaration to the parties or their attorneys of record on .
A copy of this Application and Exhibits with a blank Response and blank Income and Expense
Declaration was served on the parties or their attorneys of record on .
10. I am submitting this Application and Exhibits to the clerk of Department .
11. I am submitting this Application and Exhibits to the Superior Court Finance Department.
12. I request Abstracts of Judgment and Earnings Withholdings Orders be issued for the following reasons:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Child(ren)’s Counsel
NOTICE TO PARTIES:
You must complete the form “Response to Application for Payment of Fees and Costs of Children’s
Counsel” and follow the procedures set out in that form. Your response must be received within 21
calendar days of the date of this application. See “Payment Procedure for Children’s Attorney,” enclosed.
Failure to submit a response may result in an order directing you to pay up to 100% of the fees and costs
requested.
*or mailed to: Superior Court of California, County of Santa Clara
191 North First St., San José, CA 95113
FM-1067 REV 08/01/16
APPLICATION FOR PAYMENT OF ATTORNEY FEES AND
COSTS OF CHILDREN’S COUNSEL
Page 2 of 2
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ATTACHMENT FM-1067 201 North First Street, San Jos, (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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