Fill and Sign the Mn Attorney Claim Form

STATE OF MINNESOTA DISTRICT COURT COUNTY OF             JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No.             , Petitioner, AFFIDAVIT OF Name AND       , Respondent, Name , having been first duly sworn upon oath, states and deposes as follows: 1. I am an attorney-at-law in the law firm of Name of Law Firm , located at ___________________________________ , City , Minnesota ZipCode . The Firm formally represented Petitioner/Respondent Name of Petitioner in the above-referenced proceeding. I submit this affidavit in support of our Motion to this Court for judgment, in lieu of an attorney's lien pursuant to Minn. Stat. §481.13, for the attorney's fees and for reasonable fees and costs incurred in bringing this motion. 2. On or about Date , Petitioner/Respondent employed the Firm to represent [him/her] in the above-captioned dissolution of marriage proceeding. At that time, Petitioner/Respondent agreed to pay the Firm for services rendered at the usual hourly rates of its attorneys and assistants and further agreed to pay for the costs and disbursements connected with the representation. The agreement reached between the Firm and Petitioner/Respondent is in writing and is attached to this Affidavit as Exhibit A . 3. The Firm diligently proceeded with the dissolution of marriage action on behalf of Petitioner/Respondent . The Firm kept an accurate accounting of time expended and costs incurred at all times. The Firm submitted regular monthly billing statements for the Firm's legal services and costs incurred and demanded prompt payment from Petitioner/Respondent . The billing statements are attached and incorporated into this Affidavit as Exhibit B . 4. On Date , Petitioner/Respondent signed an Account Acknowledgment, attached as Exhibit C , in which [(s)he] acknowledged his/her outstanding amount owed on attorney's fees, as of Date , in the amount of $ _________ . The Account Acknowledgment operated as an amendment of the terms of the retainer agreement whereby Petitioner/Respondent would pay his/her account balance in monthly installments, rather than keeping current with the balance upon receipt of the monthly invoice. 5. Petitioner/Respondent made two installment payments, on Date , and on Date , and then the payments ceased. The outstanding balance Petitioner/Respondent owes the Firm for legal services rendered, as of Date , is $ ________ . 6. The Firm has demanded that Petitioner/Respondent pay this sum now due and owing to the Firm, but [(s)he] has refused to pay the sum owed. 7. The time expended and costs incurred by the Firm on Petitioner/Respondent 's behalf were reasonable and necessary to represent her throughout the duration of the Firm's employment. Petitioner acknowledged that [(s)he] found the itemized billing statements to be reasonable for the services rendered. See Account Acknowledgment, second paragraph. 8. Pursuant to paragraph 9 of the retainer agreement ( Exhibit A ), Petitioner/Respondent is obligated to pay fees and costs incurred in collecting his/her outstanding legal fees. 9. I make this Affidavit for the purpose of obtaining a money judgment against Petitioner/Respondent in the amount of $ _________ , plus reasonable attorney's fees and costs incurred in bringing this motion. - 2 - FURTHER YOUR AFFIANT SAITH NAUGHT. Dated: Attorney for Petitioner/Respondent Subscribed and sworn to before me this _____ day of ____________, 20___. _______________________________ NOTARY PUBLIC - 3 -