Certification Of Services And Request For Payment Of Arbitrator Fee {30-23}

30-23 () CERTIFICATION OF SERVICES AND REQUEST FOR PAYMENT OF ARBITRATOR FEE IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH 1021 SW 4TH AVENUE, PORTLAND OR 97204 Case No. Plaintiff/Petitioner CERTIFICATION OF SERVICES AND vs. REQUEST FOR PAYMENT OF ARBITRATOR FEE Defendant/Respondent was granted by this court (copy of deferral order and itemized statement attached) and the information required for reimbursement is: Case No: See case caption above Total Hours: Share of hours chargeable to the party with fee waiver or deferral: Total fee chargeable to party with fee waiver or deferral: DATED: Arbitrator OSB# TaxID# Printed Name: *You must attach a copy of the deferral/waiver order and copy of statement American LegalNet, Inc. www.FormsWorkFlow.com