Fill and Sign the New York Stipulation of Settlement Fee Dispute Form

UCS 137-11 (11/01) ........................................................................ In the Matter of Fee Dispute Arbitration between , Client and STIPULATION OF SETTLEMENT , Attorney ........................................................................ A request for fee arbitration havi ng been made and the parties having come to an agreement as to the reasonable amount of the fee due in this matter, it is hereby stipulated and agreed: 1. The AMOUNT IN DISPUTE is : $ ........................................ 2. The TOTAL of the AMOUNT IN DISPUTE to which the attorney is entitled is (including all costs and disbursements and amounts previously paid by the client): 3. The AMOUNT of this total PREVIOUSLY PAID by the client is: 4. (a) The BALANCE DUE by the client to the attorney is: -OR- (b) The AMOUNT TO BE REFUNDED by the attorney is: $ ........................................ $ ........................................ $ ........................................ $ ........................................ $ ........................................ It is further agreed that the payment of the am ount shall be made within _______ days of the date of this stipulation. ______________________________ ______________________________ ATTORNEY CLIENT (Please print names below signatures) Dated: _______________ [Give copy to each party] (Office Use Only) Case Number: ________________________