LSR 1 Notice of Limited Scope Representation Case Number: – Rev. 4/15 (Family Law Cases) Page 1/2 In the Circuit of County, Arkansas v. Plaintiff’s Name Defendant’s Name  Lawyer’s Information name address city zip code ( ) ( ) phone # e-mail fax #  . I am the lawyer listed in I agree to provide limited scope representation to the (check one): Plaintiff,  whose contact information for service is: Defendant,  party’s name address city state zip code ( ) ( ) phone # e-mail fax #  I agree to represent the party listed above (check all that apply): At the hearing (date): and at any continuance of that hearing  Until the court’s order after that hearing Until issues checked in below are settled, by agreement or by trial  Other (explain and give dates):  I agree to be the lawyer for this case only for the following issues (check all that apply): Child Support (check all that apply): Get an order Enforce an order    Change an order (explain): Spousal Support (check all that apply): Get an order Enforce an order    Change an order (explain): Order of Protection (check all that apply): Get an order Enforce an order    Change an order (explain):
LSR – 1 Rev. 4/15 Page 1/2 Notice of Limited Scope Representation (Family Law Cases) Case Number: In the Circuit of County, Arkansas v. Plaintiff’s Name Defendant’s Name  Lawyer’s Information name address city zip code ( ) ( ) phone # e-mail fax #  I am the lawyer listed in . I agree to provide limited scope representation to the (check one):  Plaintiff, whose contact information for service is:  Defendant, party’s name address city state zip code ( ) ( ) phone # e-mail fax #  I agree to represent the party listed above (check all that apply): At the hearing (date):  and at any continuance of that hearing Until the court’s order after that hearing Until issues checked in  below are settled, by agreement or by trial Other (explain and give dates):  I agree to be the lawyer for this case only for the following issues (check all that apply):  Child Support (check all that apply):  Get an order  Enforce an order Change an order (explain):  Spousal Support (check all that apply):  Get an order  Enforce an order Change an order (explain):  Order of Protection (check all that apply):  Get an order  Enforce an order Change an order (explain):