Case Number 

_ _    _ _ _ _   _ _ _ _ _   _ _ 
Jurisdiction     Year     Case#          Suffix  

   

 

County 
Code 
__  __ 

tate of Alabama 

Unified Judicial System 

orm FRMS-MC1    
Rev.9/2011 

 

ATTORNEY’S FEE DECLARATION 
 
Involuntary Commitments 
 

ark 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 _________________________________________, on  ___________________ (date). 

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                      $_____________________ 

                      

 

OTICE 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).   

 

 

 

 

 

 

________________________________________________________                             ________________________________________________ 
                                                   Date 
Signature of Attorney  

 

 

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) 

OTICE 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.  

HIS  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. 

iled 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. 

    S

  F

  M

  _

    (

  (

  (

  (

  (

  N

   

  _

   

  _

  _

  N

  T

  F