LAW OFFICE OF _______________



I, Robin McDermott, retain ____________, Attorney at Law, as counsel to take all steps, proceedings and actions, which counsel and myself, after discussion, find necessary to obtain settlements, verdicts, compromises, and judgments, with regard to injuries received by me on October 5, 1998.

  1. I, Robin McDermott, give my attorney, ____________, full authority to act on my behalf in all matters concerning my claims for medical expenses, present and future personal injuries, lost wages, lost employee benefits, and any other losses resulting from the personal injury of myself on October 5, 1998. I give _______________ full authority to gather medical and other evidence, enter into agreements, appear on my behalf in Court and administrative hearings, and do any other act which in his opinion and after discussion with me, we agree is appropriate.
  2. In consideration of this representation, I agree to pay ______________ thirty-five percent, (35%) of any award I receive above the actual medical expenses incurred as a result of this incident of October 5, 1998 whether or not this matter must be resolved through lawsuit.
  3. I, Robin McDermott, and my attorney, ______________, agree that the property damage settlement of eight hundred and ninety-seven dollars, ($897), is not now nor ever will be subject to this or any other agreement between us.
  4. I, Robin McDermott, agree to advance to my attorney, ______________, the sum of one hundred dollars, ($100), against any reasonable and necessary costs and expenses he may incur on my behalf .
  5. My attorney, ___________, agrees to provide me with a detailed statement of said reasonable and necessary costs and expenses he may incur on my behalf and to apply any unused portion of said amount toward the thirty-five percent consideration agreed by the parties for his services as outlined above.
DATED: 23 December 1998 ________________________________________

Robin McDermott

DATED: _______________ _________________________________________

______________attorney name

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