ANNEX 1 -- REQUEST FOR FINAL FEE AND EXPENSE AWARD FEES: Applicant_____________________________________________________________________________ Representing__________________________________________________________________________ 1. 2. 3. 4. 5. 6. 7. 8. Period of Services in this Case ____/____/______to____/____/______ Total Hours of Service in this Case ________________ Avg. Hourly Rate per Fee Requested $_______________ Total Fee Award Requested $_______________ Retainer Credited Against Award $_______________ Interims Credited Against Award $_______________ Final Payment Requested $_______________ Approximate Total Amount of Distribution to all Creditors to Be Made in this Case (e.g., administrative, secured and unsecured) $_______________ EXPENSES: 1. Total Expense Reimbursement Requested 2. Expense Reimbursement to Date 3. Expense Request for Final Period 4. Breakdown of Item No. 3 Total: a. Travel Expense b. Postage c. Photocopies (max. 10¢/pg.) d. Express Mail/Messenger e. Overtime Charges f. Other Expenses (Itemize): $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ LBF 2016-1A (Eff. 2/1/13) American LegalNet, Inc. www.FormsWorkFlow.com