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PAYMENT INFORMATION FAMILY COURT COUNSELING SERVICE FEES MEDIATION IF PREVIOUSLY REFERRED ALL EXTENDED MEDIATION STUDY/EVALUATION 100. 00 500. 00/ 750/ 1 500 If paying by cash cashier s check money order or personal check made payable to the Dane County Clerk of Circuit Court use this form and make payment directly to the Dane County Clerk of Circuit Courts Dane County Courthouse 215 S Hamilton St Room 1000 Madison WI 53703-3285 by mail or in person. Debit and credit card payments Discover MasterCard Visa American Express can be paid 24 hours by phone 888-604-7888 or online www. 00 500. 00/ 750/ 1 500 If paying by cash cashier s check money order or personal check made payable to the Dane County Clerk of Circuit Court use this form and make payment directly to the Dane County Clerk of Circuit Courts Dane County Courthouse 215 S Hamilton St Room 1000 Madison WI 53703-3285 by mail or in person. Debit and credit card payments Discover MasterCard Visa American Express can be paid 24 hours by phone 888-604-7888 or online www. governmentpayment. com Make a Payment. Note the additional fee to Government Payment Service if paid by phone 4. 75 or online 3. 5. Use Pay Location Code 5479. If eligible you may receive a fee waiver from a Circuit Court Commissioner Dane County Courthouse 215 S Hamilton St Room 2000 based on current financial information. The Application for Waiver of Family Court Counseling Fee can be found at the Commissioner Center Room 2000 Legal Resource Center Room L1007 and online www. PAYMENT INFORMATION FAMILY COURT COUNSELING SERVICE FEES MEDIATION IF PREVIOUSLY REFERRED ALL EXTENDED MEDIATION STUDY/EVALUATION 100. 00 500. 00/ 750/ 1 500 If paying by cash cashier s check money order or personal check made payable to the Dane County Clerk of Circuit Court use this form and make payment directly to the Dane County Clerk of Circuit Courts Dane County Courthouse 215 S Hamilton St Room 1000 Madison WI 53703-3285 by mail or in person* Debit and credit card payments Discover MasterCard Visa American Express can be paid 24 hours by phone 888-604-7888 or online www. governmentpayment. com Make a Payment. Note the additional fee to Government Payment Service if paid by phone 4. 75 or online 3. 5. Use Pay Location Code 5479. If eligible you may receive a fee waiver from a Circuit Court Commissioner Dane County Courthouse 215 S Hamilton St Room 2000 based on current financial information* The Application for Waiver of Family Court Counseling Fee can be found at the Commissioner Center Room 2000 Legal Resource Center Room L1007 and online www. countyofdane. com Clerk of Courts Court Forms Family Court Forms. Note that this form must be notarized and supporting documentation submitted* Payment for Family Court Counseling Services is Court Ordered* Failure to comply will result in an Order To Show Cause Contempt Hearing and a Judgment being entered for the fees. The Court may readjust the allocation of fee payment at a later date. PAYMENT RECEIPT Use this form for payment by cash check or money order to the Clerk of Courts office.

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