FAMILY COURT SERVICES PAYMENT FORM

All mediation/custody evaluation services provided by Family Court Services are on a fee basis. The fees established are the following:

Mediation Fee - $250.00

-	$125.00 each parent when ordered by the Court.
-	$250.00 by requesting parent, if not ordered by the Court.

Custody Evaluations ordered by the court:

$45.00 per hour
$700.00 retainer fee upfront ($350.00 per parent)

The fee is payable in advance of service, directly to the Outagamie County Clerk of Courts, Outagamie County Government Center, 320 S. Walnut Street, Appleton, WI 54911. Payment cannot be accepted at the Family Court Services office. The Clerk of Courts will accept personal checks, cashier’s checks, cash, money orders, and credit/debit card payment (credit or debit card payment will not be accepted over the telephone.  In-person payment only).  Checks should be made payable to the Clerk of Courts.

If you feel that you are unable to afford the entire fee, you may complete a request form to have the fee waived. The determination of a waiver is made by the Family Court Commissioner. The form is available online at www.outagamie.org under Family Court Services, or by calling our office at (920) 832-5660 between 8:00 a.m. and 4:30 p.m., Monday through Friday.

Court File No.  	

Use this form for payment to the Clerk of Courts.  Payment should be made at the earliest possible opportunity in order to have a mediator assigned to work with you. This payment form will be filed in the Family Court Services office after validation by the Clerk of Courts.

Name & Address
of Payer:	 	

Name & Address
of Other Parent:	 	

Amount Enclosed:	 	

Date Paid:    	

Payment for:		Mediation		Custody Evaluation

NOTE:  If any portion of the fees were waived, please attach a copy of the waiver form.