Attorney Fee Response Form
Revised: 08/2013, CN: 10861 page 2 of 2
6. Was one or more itemized bills submitted to the client? Yes No
Dates bills were provided to client:
7. If client made payments on bill, attach itemized list showing date(s) received and amounts.
8. Did you maintain time records in this case? Yes No (If yes, attach copies)
If not, why not?
9. Have you brought a lawsuit for your fees, or are the fees at issue in any court proceeding? Yes No
(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? Yes Date: No
(If yes, attach a copy)
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? Yes No
If so, state the correct names below and serve them in accordance with R. 1:20A-3(b).
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.
(Please Print Name Below Signature)
Please Notify District Secretary of Disability Accommodation Needs.