Fill and Sign the How to File a Complaint Fee Board of Overseers of the Bar Form

VERIFIED PETITION TO ARBITRATE FEE DISPUTE DATE OF PETITION: _______________________________________________ PETITIONER’S NAME: _____________________________________________ PETITIONER’S ADDRESS: __________________________________________ __________________________________________ TELEPHONE NUMBER: (Day) _________________(Evening)_______________ NAME OF LAWYER (S) WITH WHOM PETITIONER HAS A DISPUTE: ________________________________ NAME OF YOUR CURRENT LAWYER if any____________________________ AREA OF LAW (please check): ______ Family Law (Divorce, Child Support, Custody, etc.) ______ Probate (Wills, Trusts, Guardians or Conservators) ______ Bankruptcy ______ Personal Injury ______ Criminal ______ Contracts ______ Property Rights ______ Other The fee arbitration process is designed to address the following issue only: AMOUNT IN CONTROVERSY: If this dispute involves a fee, how much do you believe is owing, and t o whom? Amount Owed $_________________ To Whom? __________________ Provide a concise statement of the facts of this controversy. Please include the nature of the problem the attorney was helping you with. State whether there was a written fee agreement. If you have a copy, please attach the same. Attach copies of all pertinent documents or other written evid ence in support of your position. If more space is needed to describe your situation, please attach additional pages. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Petitioner hereby certifies that the foregoing statements are true and correct to the best of his/her knowledge and belief. __________________________________ Petitioner’s signature State of Utah ) : s s. County of_________________) Subscribed and sworn to before me this_______ day of _____________, 200___. ______________________________ ______________________________ My commission expires. Notary Public Residing in:____________________