IN THE CIRCUIT COURT OF __________________ COUNTY, WEST VIRGINIA
IN RE: Compensation of ________________________________________________
[Name of Mental Hygiene Commissioner]
Administrative Order No. ________- AD -________
FOR PAYMENT OF MENTAL HYGIENE COMMISSIONER
[W.Va. Code: §27-5-1(b)]
On the _______ day of ____________________, 20_____, came the above named Mental Hygiene Commissioner and
presented to the Court his/her itemized statement of cases and/or for services rendered and fees, a copy of which is attached hereto and
made a part of this Order.
This Court has reviewed the statement and FINDS it to be reasonable and properly documented and does hereby ORDER
that payment be made to the Mental Hygiene Commissioner in the amount of $ ________________.
The Clerk of this Court is directed to record this Order in the appropriate Order Book of this Court and to transmit an original
certified copy of this Order, along with the statement attached hereto, to the Administrator's Office of the West Virginia Supreme
Court of Appeals for payment.
CIRCUIT COURT JUDGE
SCA-MH 925 / 5-01