State Seal of Colorado
Billing Form for Pre-Approved Situations
Colorado Office of the Child's Representative


Case Information

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I am the... *
Appointment Authority *
 
Indigency: Indigency is required for Title 14 Domestic Relations cases, and Title 19 Paternity Cases in which parenting time is at issue, and Title 15 Probate cases.
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Payment request as determined by indigency status above *

Payment Request

Instructions: Fill in the blanks as needed to summarize your billed activities. If desired, click "Calculate" to see subtotals or the grand total in dollars. All dollar amounts are automatically calculated when you submit your form.
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x $75/hr =
$0.00
x $30/hr =
$0.00
x $0.49/mile =
$0.00
x $0.48/mile =
$0.00
x $0.10/copy =
$0.00
_______________________________________________
Grand Total
$0.00
Payment request
as determined by
indigency status
(% indicated above)
$0.00
Required Documentation
(Receipts and/or itemization of in-court and out-of-court hours.) *
Instructions for Paper Form: Complete the remainder of this form and click "Submit" at the bottom. You will be e-mailed a printer-friendly copy of your form to mail to OCR with any required documentation.


Please combine receipts into one file to upload.

Certification

The information in the above form is true.  No compensation for the services described has been received.  I will provide accurate itemization of the in-court and out-of-court hours and receipts (uploaded here or will mail).  I have reviewed the procedures in Chief Justice Directive 97-02, and subsequent directives, and understand that payment may be adjusted for items that do not comply with the Office of the Child's Representative's procedures. *