Chapter 1 - FORM 1-3 : FINAL DISBURSEMENT STATEMENT (C.R.C.P. CH 23.3, FORM 2)

• Jurisdiction: Colorado

Form 1-3: Final Disbursement Statement (C.R.C.P. ch 23.3, Form 2)

FINAL DISBURSEMENT STATEMENT

GROSS RECOVERY......................................................................................$ __________

Itemization of expenses incurred in handling of case:

__________ $ __________

__________ $ __________

__________ $ __________

__________ $ __________

Total Expenses $ __________

Amount of Expenses Advanced by Attorney $ __________

Amount of Expenses Paid by Client $ __________

NET RECOVERY............................................................................................$ __________

Computation of Contingent Fee: __________% of (Net) (Gross)

Recovery = $ __________

Total Fee (and expenses advanced by attorney)* $ __________

DISBURSEMENT TO...