Free CG 921 - West Virginia

GUARDIANSHIP/CONSERVATORSHIP SERVICES Appointed Attorney Voucher and Expense Statement From: _____________________________________________, Appointed Attorney. This claim relates to guardianship/conservatorship proceedings in _________________ County, WV. Case No. ____________________ Date of appointment: _________________________

Alleged protected person: __________________________ Date of disposition: ________________ 1. The following services were rendered in this proceeding: TIME CODE CLASSIFICATIONS IN-COURT H-Hearings W-Waiting in court O-Other (specify): _______________ _____________ _____________ OUT-OF-COURT D-Driving/travel C-Conferences with client/witnesses R-Research, preparation of pleadings O-Other (specify): _______________ _______________

Use additional sheets properly numbered and identified if necessary. ONLY ONE ITEM, "IN" OR "OUT" PER LINE

Itemized time must be in tenths of an hour. DATE
TIME CODE ATTY TIME INCOURT ATTY TIME OUTCOURT LOCATION OF ACTIVITY; FURTHER EXPLANATIONS, NOTES OR COMMENTS

TOTALS THIS SHEET Number of Additional Time Sheets

___________________________ ___________________________ = $____________ = $____________ $_____________

TOTAL TIME IN COURT ___________ x $65.00 TOTAL TIME OUT OF COURT ___________ x $45.00 TOTAL FEE CLAIM
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SCA-CG 921-2/1/-95

G/C ATTORNEY SERVICES VOUCHER AND EXPENSES.

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II.

The following allowable expenses were incurred in this proceeding: EXPENSE CODE:

Use additional sheets properly numbered and identified if necessary.

1. Mileage 2. Photocopying 3. Other (specify): __________________________

ONLY ONE ITEM PER LINE DATE EXP. CODE NOTES OR COMMENTS COST

TOTAL EXPENSES CLAIMED THIS VOUCHER $ ______________ III. Total Fee Claim Total All Expense Claims Total Claim for Proceeding $ ____________ $ ____________ $ ____________

I hereby affirm that the above statements are true and correct. ___________________ DATE ___________________________________________________ ATTORNEY SIGNATURE

_______________________________________________________________________________________ NAME OF PERSON OR FIRM RECEIVING PAYMENT S.S.N. OR F.E.I.N. _______________________________________________________________________________________ ADDRESS TELEPHONE NUMBER

SCA-CG 921-2/1/-95