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Here is the text we could read:

THE PEOPLE OF

The State of Michigan

In the matter of

Defendant’s/Respondent’s name, address, and telephone no.

CTN/TCN

SID

STATEMENT OF SERVICE

Name (type or print)

1. I,

Specify attorney, lawyer-guardian ad litem, etc.

Name (type or print)

2. Compensation from any other source is not being sought.

for

, and services have been rendered.

, was appointed by the court to serve as the

3. Dates and the nature of services rendered and expenses are as follows:

DATE

SERVICE/EXPENSE

TIME

DATE

SERVICE/EXPENSE

TIME

Date

Federal identification no.

Attorney/Guardian ad litem/Lawyer-Guardian ad litem signature Bar no.

Address

City, state, zip Telephone no.

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITCOUNTY STATEMENT OF SERVICE ANDORDER FOR PAYMENT OFCOURT-APPOINTED REPRESENTATIVECASE NO. and JUDGEORIMI-Court addressCourt telephone no.Approved, SCAOForm MC 221, Rev. 1/21Page 1 of 2Distribute form to: Court AttorneyJIS Code: ASEStatement of Service and Order for Payment of Court-Appointed Representative
Page 2 of 2

(1/21)

Case No.

ORDER FOR PAYMENT

I certify that

child(ren) and that the service was rendered.

was appointed to represent the named defendant/respondent/

IT IS ORDERED

District control unit/County

disbursing officer shall pay $

to compensate him/her for all time and expense in connection with this case.

Name (type or print)

Check no.

Judge signature and date

in the amount of $

issued on

Date

MC 221, Statement of Service and Order for Payment of Court-Appointed Representative

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/general-use (2023-03)
Page(s): 2
Fields(s): 91
Average fields per page: 45
Reading Level: Grade 9
LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

undefined__1 was undefined (0.55 conf)
th_e_peopl was THE PEOPLE OF (0.47 conf)
defendant_respondent_address was DefendantRespondent name address and telephone no (0.49 conf)
undefined__2 was undefined_2 (0.39 conf)
ctn was CTN (0.42 conf)
sid was SID (0.35 conf)
matter was In the matter of (0.33 conf)
name_type_print__1 was Name type or print (0.45 conf)
specify_attorney_ad was Specify attorney lawyerguardian ad litem etc (0.37 conf)
name_type_print__2 was Name type or print_2 (0.40 conf)
signature_date was Date (1.00 conf)
bar was Bar no (0.41 conf)
federal_identification was Federal identification no (0.55 conf)
users1_address_line_one was Address (1.00 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone was Telephone no (0.44 conf)
text__1 was Text1 (0.35 conf)
text__2 was Text2 (0.35 conf)
text__3 was Text3 (0.35 conf)
judge was Judge (0.39 conf)
text__4 was Text5 (0.35 conf)
text__5 was Text6 (0.35 conf)
text__6 was Text7 (0.35 conf)
text__7 was Text8 (0.35 conf)
date_row__1 was DATERow2 (0.42 conf)
date_row__2 was DATERow3 (0.42 conf)
date_row__3 was DATERow4 (0.42 conf)
date_row__4 was DATERow5 (0.42 conf)
date_row__5 was DATERow6 (0.42 conf)
date_row__6 was DATERow7 (0.42 conf)
date_row__7 was DATERow1 (0.42 conf)
date_row__8 was DATERow8 (0.42 conf)
date_row__9 was DATERow9 (0.42 conf)
date_row__10 was DATERow10 (0.42 conf)
serviceexpense_row__1 was SERVICEEXPENSERow1 (0.35 conf)
serviceexpense_row__2 was SERVICEEXPENSERow2 (0.35 conf)
serviceexpense_row__3 was SERVICEEXPENSERow3 (0.35 conf)
serviceexpense_row__4 was SERVICEEXPENSERow4 (0.35 conf)
serviceexpense_row__5 was SERVICEEXPENSERow5 (0.35 conf)
serviceexpense_row__6 was SERVICEEXPENSERow6 (0.35 conf)
serviceexpense_row__7 was SERVICEEXPENSERow7 (0.35 conf)
serviceexpense_row__8 was SERVICEEXPENSERow8 (0.35 conf)
serviceexpense_row__9 was SERVICEEXPENSERow9 (0.35 conf)
serviceexpense_row__10 was SERVICEEXPENSERow10 (0.35 conf)
time_row__1 was TIMERow1 (0.45 conf)
time_row__2 was TIMERow2 (0.45 conf)
time_row__3 was TIMERow3 (0.45 conf)
time_row__4 was TIMERow4 (0.45 conf)
time_row__5 was TIMERow6 (0.45 conf)
time_row__6 was TIMERow7 (0.45 conf)
time_row__7 was TIMERow8 (0.45 conf)
time_row__8 was TIMERow9 (0.45 conf)
time_row__9 was TIMERow10 (0.45 conf)
date_row__11 was DATERow1_2 (0.35 conf)
date_row__12 was DATERow1_3 (0.35 conf)
date_row__13 was DATERow1_4 (0.35 conf)
date_row__14 was DATERow1_5 (0.35 conf)
date_row__15 was DATERow1_6 (0.35 conf)
date_row__16 was DATERow1_7 (0.35 conf)
date_row__17 was DATERow1_8 (0.35 conf)
date_row__18 was DATERow1_9 (0.35 conf)
date_row__19 was DATERow1_10 (0.35 conf)
date_row__20 was DATERow1_11 (0.35 conf)
serviceexpense_row__11 was SERVICEEXPENSERow1_2 (0.38 conf)
serviceexpense_row__12 was SERVICEEXPENSERow1_3 (0.38 conf)
serviceexpense_row__13 was SERVICEEXPENSERow1_4 (0.38 conf)
serviceexpense_row__14 was SERVICEEXPENSERow1_5 (0.38 conf)
serviceexpense_row__15 was SERVICEEXPENSERow1_6 (0.38 conf)
serviceexpense_row__16 was SERVICEEXPENSERow1_7 (0.38 conf)
serviceexpense_row__17 was SERVICEEXPENSERow1_8 (0.38 conf)
serviceexpense_row__18 was SERVICEEXPENSERow1_9 (0.38 conf)
serviceexpense_row__19 was SERVICEEXPENSERow1_10 (0.38 conf)
serviceexpense_row__20 was SERVICEEXPENSERow1_11 (0.38 conf)
time_row__10 was TIMERow1_2 (0.39 conf)
time_row__11 was TIMERow1_3 (0.39 conf)
time_row__12 was TIMERow1_4 (0.39 conf)
time_row__13 was TIMERow1_5 (0.39 conf)
time_row__14 was TIMERow1_6 (0.39 conf)
time_row__15 was TIMERow1_7 (0.39 conf)
time_row__16 was TIMERow1_8 (0.39 conf)
time_row__17 was TIMERow1_9 (0.39 conf)
time_row__18 was TIMERow1_10 (0.39 conf)
time_row__19 was TIMERow1_11 (0.39 conf)
time_row__20 was TIMERow5 (0.45 conf)
certify was I certify that (0.41 conf)
disbursing_officer_shall_pay was disbursing officer shall pay (0.48 conf)
ordere__1 was IT IS ORDERED 1 (0.25 conf)
ordere__2 was IT IS ORDERED 2 (0.25 conf)
check was Check no (0.40 conf)
amount was in the amount of (0.37 conf)
issued was issued on (0.43 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

MC 221, Statement of Service and Order for Payment of Court-Appointed Representative

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02