Litigation Fund Request Form

The Litigation Fund is available ONLY to Judicare and pro bono attorneys handling cases through MLSC-funded agencies. Please complete all required information below and attach supporting documentation for EACH FY21 expense claimed in your request. FY21 expenses are those incurred July 1, 2020 to June 30, 2021. All requests for FY21 expenses must be received by PBRC no later than July 1, 2021.  

Tell us about yourself! Please type full names and addresses as you'd like communications to be addressed.






Primary or Home Address





Work Address (if any)







Phone Contact (s) (XXX-XXX-XXXX)






CASE & EXPENSES INFORMATION 

Please include all expenses related to this case. To add another case's expenses, click the link under the bottom-right side of this double-lined box. 






MILEAGE EXPENSES






$
EXPENSES OTHER THAN MILEAGE




$
TOTAL CASE EXPENSES

$