Tax Exemption Request

Attorney Name *

Team Name *If attorney is not part of a team, write NONE

Email Address *

Confirm Email Address *

Cause Number *

County *

Type of Case *(e.g., Divorce, SAPCR, Enforcement, Protective Order, etc.)

Name of Pro Bono Case Agency from Which Case Received *(If no agency used, describe how obtained)

Date Pro Bono Case Taken *

Date Pro Bono Case Completed *

Did you have to participate in a contested hearing on this case? *YesNo

Did you have to attend mediation on this case? *YesNo

Did you have to attend a bench trial in this case? *YesNo

Did you have a jury trial in this case? *YesNo

Number of Hours Spent on Pro Bono Case

Names of Other Attorneys That Worked on Case (if any)

Number of Hours each Other Attorney spent Working on the Case

Date Initially Requested Pro Bono Case from Pro Bono Agency

Request Tax Exemption for Publication Purchases