ARBITRATOR’S FEE STATEMENT

Cal. Form L-0190

California Superior Local Rules

s) Requested $ 150.00 TOTAL: Review and Authorization Accounting Services Approval Account Coding G/L Acct. Cost/Fund Center WBS Element Functional Area PCT Fund Tax Code Amount SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Harbor - Newport Beach Facility - 4601 Jamboree Rd, Newport Beach, CA 92660-2895 North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 West - 8141 13th Street, Westminster, CA 92683-4593 Arbitrator Name and Address: Telephone No.

Fax No. (Optional) E-Mail Address (Optional) SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Harbor - Newport Beach Facility - 4601 Jamboree Rd, Newport Beach, CA 92660-2895 L_]North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 L_]West - 8141 13th Street, Westminster, CA 92683-4593 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: ARBITRATOR ’ S FEE STATEMENT Pursuant to California Rules of Court, rule 3.819 and Local Rules - Superior Court of California, County of Orange, rule 360, the following fee(

s) are requested for conducting arbitration proceedings in the above-named case. (Attach a declaration to support payment of fees if the case settled at the hearing, no hearing was conducted or extraordinary fees are requested.) Date session concluded: Date Award or Settlement filed with the Court: Name of Arbitrator: Fee(

s) Requested Name of Payee: Fee for entire session: $150.00 Address of Payee: Extraordinary fees: TOTAL: Last four digits of your Social Security # or your full Taxpayer Identification #:, A current signed IRS Form W-9 or Payee Data Records is: [] attached [] has been submitted to the Court I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Arbitrator: (For Clerk's Use Only) DAVID H.

YAMASAKI, Clerk of the Court Amount approved: S, By: Authorization Deputy Clerk (For Accounting Services Use Only) Account Coding GiL Acct. | Cost/Fund Genter | WBS Element | Functional AreaPCT | Fund | Tax Code ‘ Amount 939102 306311 Review and Authorization Accounting Services Approval Date By: Date: Authorized By: ARBITRATOR ’ S FEE STATEMENT Approved for Optional Use California Rules of Court, rule 3.819 L-0190 (Rev. Dec, 2016)

Document details

Collection	California Superior Local Rules
Citation	Cal. Form L-0190
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	c05a4afd9d2e42656e0f507611d08ecdd36cbb92

Source file is stored in the law ingest library (pdf).