Form Frms Mc1 – Fill Out and Use This PDF

State of Alabama	ATTORNEY’S FEE DECLARATION			County	Case Number
Unified Judicial System
Form FRMS-MC1				Code
				__ __	_ _ _ _ _ _ _ _ _ _ _ _ _
Rev.9/2011		Involuntary Commitments
					Jurisdiction Year Case# Suffix
Mark Appropriate Court:			Attorney Name (Please type or print):
___Probate Court			______________________________________________
___Circuit Court
___Alabama Court of Civil Appeals		All Limits: $1500	______________________________________________
			Social Security Number or FEIN
In the matter of ___________________________________________			___Commitment	___Recommitment ___Appeal
Respondent/Patient Name

The undersigned attorney, licensed to practice law in the State of Alabama, declares that on (date) ____________________________, the Honorable

________________________________________, Probate Judge, appointed the undersigned to serve as Advocate for the Petitioner,

or Guardian Litem, and the case was disposed of by _____________________________________________________.

(1)	In Court Legal Services	Total Hours __________ x	$ 70.00	per hour = $__________________
(2)	Out-of-Court Legal Services	Total Hours __________ x	$ 70.00 per hour = $__________________
(3)	Appellate Level Legal Services	Total Hours __________ x	$ 70.00	per hour = $__________________
(4)	Expert Expenses (If approved in advance by the court)				= $__________________
(5)	Reimbursable Non-overhead Expenses (Receipts attached)				=$__________________
	(Must be approved in advance if in excess of $300)
		TOTAL CLAIM OF ATTORNEY			$_____________________

NOTICE TO ATTORNEY: Complete this form. Attach a copy of a complete itemization of (1) in-court legal services; (2) out-of-court legal services; (3) appellate level legal services; (4) expert expenses; and/or (5) reimbursable non-overhead expenses reflecting the date of actions and amount of time involved in each activity. Attach original invoice or receipt for all expenses and corresponding court orders. Make a copy of same for the court’s record and a copy or your records. This form and attachments must be received by the State Comptroller’s Office, Fiscal Management through the

Probate Court no later than 90 days from final disposition of the case.

I, the undersigned attorney, declare that the above claim is true and correct and represents indigent legal services actually rendered as an attorney and that the amount is due and payable. I further declare that the above claim is not a duplication of charges and expenses in any case (companion or otherwise).

________________________________________________________	________________________________________________
Signature of Attorney	Date
Attorney Code ____________________________________________
	E-mail Address:_____________________________________
Mailing Address of Attorney

(please type or print) (including city, state, and zip code)

_________________________________________________________________	Telephone Number:__________________________________
_________________________________________________________________	Fax Number: ________________________________________

I, the undersigned probate judge/judge, hereby certify that the attorney presenting this claim provided representation in this matter, that said matter has been concluded, and that to the best of my knowledge, the bill is reasonable based on the defense provided and the appointment date listed above is correct as stated.

________________________________________	__________________________________________________
Probate Judge’s Signature	Date
________________________________________
Judge’s Signature (Appeals Court other than Probate)

NOTICE TO ATTORNEY AND JUDGE: Ala. Code (1975) §§22-52-14 et seq. provide for the payment of attorney fees and expenses incurred by counsel appointed to represent indigent defendants in probate court proceedings.

THIS FORM MUST CONTAIN ORIGINAL SIGNATURES OF THE ATTORNEY AND THE JUDGE. THIS FORM WITH ATTACHED ITEMIZATION MUST BE SUBMITTED TO THE PROBATE JUDGE FOR CERTIFICATION, FILED WITH THE CLERK, AND THEN SUBMITTED TO THE STATE COMPTROLLER’S OFFICE, FISCAL MANAGEMENT.

Filed in the Clerk’s Office at ____________________________________________________, Alabama, on __________________________.

date

PROBATE COURT MAIL FORM ATTACHED TO PROBATE JUDGE DECLARATION SHEET TO: State Comptroller’s Office, Fiscal Management, 100 N Union St, Suite 216, Montgomery, Al 36130.