Attorney Trust Account Closing Statement
Closing Statement
Client: __________________________________________________________________
Matter __________________________________________________________________
|Settlement Proceeds: | $________ |
| | |
|Less Attorneys’ Fee (___%) |$________ |
| | |
|(Insert Firm Name of Co-Counsel, if Applicable) |$________ |
| | |
|Total Attorneys’ Fees: |$________ |
| | |
|Less Costs Incurred During Suit |$________ |
| | |
|Less Future Costs |$________ |
| | |
|Total Costs |$________ |
| | |
|Less Outstanding Bills |$________ |
| | |
|(Any medical bills or other costs to be paid) | |
| | |
|NET PROCEEDS: |$________ |
(I) (WE) approve the disbursements shown above, and upon the receipt of ___________________________________ dollars, (I) (WE) acknowledge that (I) (WE) have been paid in full from the recovery in (MY) (OUR) case and that (I) (WE) will holds the law firm(s) (insert name of firms) harmless from any additional bills incurred not mentioned above. (I) (WE) understand that the unused balance, if any, of future costs will be refunded to (ME) (US) in approximately two months.
DATED this _______________ day of ________, 20___.
FIRM NAME
FIRM ADDRESS
CITY, STATE, ZIP CODE
PHONE
________________________
Client’s Signature
BY: ________________________
(Signature of Attorney)
................
................
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