Affadavit Of Indigency Parent Attorney Form (Page 3 of 4) in pdf

IN THE JUVENILE COURT FOR ANDERSON COUNTY, TENNESSEE

STATE OF TENNESSEE

CHILD/CHILDREN

UNDER THE AGE OF EIGHTEEN

IN THE MATTER OF

______________________________________________________

)

J-___________________/ _______-______________________

______________________________________________________

)

J-___________________/ _______-______________________

______________________________________________________

)

J-___________________/_______-_______________________

______________________________________________________

)

J-___________________/_______-_______________________

ORDER APPOINTING COUNSEL FOR INDIGENT PARTY IN DEPENDENCY-NEGLECT

OR TERMINATION OF PARENTAL RIGHTS PROCEEDING

It appears to the court from the affidavit of indigency filed in this matter that the respondent ,

_________________________________

, is entitled to court-appointed counsel pursuant to

T.C.A. 37-1-126 and S. Ct. Rule 13, Sec. 1(d)(2).

_________________________________

It is therefore ordered that

, is appointed as

counsel for this respondent and is entitled to compensation at the hourly rate and subject to the maximum

compensation set forth in Tenn. Sup. Ct. Rule 13, Sec. 2(d) and (e). Appointed counsel

shall represent the respondent in the following matters, unless relieved in a subsequent order:

from the filing of the dependency petition through disposition;

in post disposition, foster care review and permanency proceedings;

from the filing of the termination of parental rights petition to conclusion of trial;

on appeal to circuit court, Tennessee Court of Appeals and/or Tennessee Supreme

Court.

For purposes of compensation pursuant to Rule 13, each of the above is considered a separate proceeding. Counsel is entitled to

submit separate claim forms for each proceeding and to be compensated up to the maximum amount allowed for each case as if it were the

result of a separate appointment. Claims must be supported with a copy of the court order appointing counsel. Counsel is entitled to

payment of expenses incident to appointed counsel’s representation. Counsel is entitled to payment of specific expenses without prior

approval as defined in Tenn. Sup. Ct. Rule 13, Sec. 4(e)(3). All other expenses must receive prior approval of this court and the director of

the Administrative Office of the Courts in accordance with Tenn. Sup. Ct. Rule 13, Sec. 4(b).

1. __________Approved __________Approved w/reimbursement _________Not Approved

_______Public Defender Appointed ________ Private Counsel Approved _____________________________________________

Address_____________________________________________________________________ Phone_________________________

2. The Defendant/Parent are to contact the Public Defender’s Office at 457-0006 or contact the Private Counsel appointed to your

case immediately to set up an appointment. If not approved, Defendant will either need to retain an attorney and inform the Court of who

that person is immediately or sign the enclosed waiver and return it to the court immediately.

3. Attorney Administrative Fee: _____Waived _________Ordered; Amount: $50.00 includes Clerk’s fee

Other:___________________________________(includes Clerk’s fee), pursuant to T.C.A. 37-1-126. To be paid to the Juvenile Court

CERTIFICATE OF SERVICE

Clerk within 30 days.

I hereby certify that a true and exact copy of the Order has been

served on all parties indicated by hand delivery or by placing a true

and exact copy of the same in U.S. Mail, postage pre-paid, to their

THIS the __________day of _______________________, 20______ .

last known address(es).

________________________________________________________

This the _______day of_________________________20 ______

JUDGE

_____________________________________________________

Court Officer/Deputy Clerk

Affadavit Of Indigency Parent Attorney Form Page 3

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