Form 13-12

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Expense Report of [Attorney Ad Litem/Guardian Ad Litem/Amicus Attorney]

By [separate order of this Court/agreement of the parties], [name] [was appointed/agreed to serve] as [Attorney Ad Litem/Guardian Ad Litem/Amicus Attorney] to represent [name[s] of child[ren]].

In compliance with Texas Supreme Court Miscellaneous Docket Order No. 94-9143, I submit the following information to the Court:

$[amount] is my normal hourly fee, and I represent to the Court that this fee is reason­able for individuals with my education, training, and experience in [county] County, Texas.

$[amount] is my total out-of-pocket expenditure in the performance of my duties as [Attorney Ad Litem/Guardian Ad Litem/Amicus Attorney], but I request no reimbursement for any expenditure for which I have not attached, to this report, documentation.

The number of hours (to the nearest tenth) I worked in performance of my duties as [Attorney Ad Litem/Guardian Ad Litem/Amicus Attorney] is [number], and I have attached a summary indicating what I did and when.

I request the sum of $[amount] for reasonable fees and expenses for this appointment. Of this amount, [list amounts paid and the payee for each amount].

Respectfully submitted on [date].

   
[Name]
[Attorney Ad Litem/Guardian Ad
      Litem/Amicus Attorney] for [name[s]]
State Bar No.: [if applicable]
[E-mail address]
[Address]
[Telephone]
[Fax]

ORDERED on ______________________________.

   
JUDGE PRESIDING