Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY Attorney for UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: CHAPTER ________ CASE NUMBER DATE: TIME: Debtor. COURTROOM: APPLICATION FOR PAYMENT OF: INTERIM FEES AND/OR EXPENSES (11 U.S.C. § 331) FINAL FEES AND/OR EXPENSES (11 U.S.C. § 330) 1. Name of Applicant (specify): 2. Type of Services Rendered: a. Attorney for (specify): b. Accountant for (specify): c. Other Professional (specify): 3. Date of Filing of Petition under Chapter _____ of the Bankruptcy Code: 4. Date of Entry of Order Approving Applicant's Employment: 5. Date of Filing of last Fee and/or Expense Application: 6. Total Fees allowed or paid to Applicant to Date (including Retainers and Prior Approved Fee Applications): $ a. Retainer received: $ b. Retainer remaining as of the date of this application: $ c. Total amount requested in all prior applications: $ d. Total amount actually paid pursuant to prior approved applications: $ e. Total amount currently due but unpaid pursuant to prior approved applications: $ f. Total amount allowed but reserved pending final fee application: $ (Continued on next page) This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2016-1.2 F 2016-1.2 Fee/Expense Application - Page 2 In re CHAPTER _______ Debtor. CASE NUMBER 7. Summary of Requested Fees: (Attach detailed supporting documentation to this Application) Professional Person’s Name a. b. c. d. e. f. g. Hourly Rate $ $ $ $ $ $ Continued on Attached Page x Total Hours this Person Total Fees this Person = = = = = = x x x x x x = $ $ $ $ $ $ 8. The hourly rates above are the same rates charged by the above professionals for non-bankruptcy services except as See Attached Page follows: 9. Bonus requested (final fee applications only): $ (Attach Declaration and Memorandum of Points and Authorities justifying bonus) 10. TOTAL FEES REQUESTED THIS APPLICATION: $ 11. Total Expenses paid to Applicant to Date (including Retainers and Prior Approved Expense Applications): $ 12. Summary of Requested Expense Reimbursement: (Attach detailed supporting documentation to this Application) Type of Expense Reimbursement Requested this Application a. b. c. d. e. f. g. $ $ $ $ $ $ Continued on Attached Page 13. TOTAL EXPENSE REIMBURSEMENT REQUESTED THIS APPLICATION: $ 14. Applicant submits the following in support of the Application herein pursuant to Local Bankruptcy Rule 2016-1 (specify): 15. Total Number of attached pages of supporting documentation: ________ 16. Applicant declares under penalty of perjury under the laws of the United States of America that the foregoing Application and all attached supporting documentation are true and correct and accurately reflect services rendered and expenses incurred. 17. Executed on the ______ day of ___________________, 20______, at _____________________________, California. _______________________________________ Type Name of Applicant ________________________________________ Signature of Applicant This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2016-1.2 F 2016-1.2 Fee/Expense Application - Page 3 In re CHAPTER _______ Debtor. CASE NUMBER NOTE: When using this form to indicate service of a proposed order, DO NOT list any person or entity in Category I. Proposed orders do not generate an NEF because only orders that have been entered are placed on a CM/ECF docket. PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document described as will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d), and (b) in the manner indicated below: I. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s) (“LBR”), the foregoing document will be served by the court via NEF and hyperlink to the document. On ________________________ I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email addressed indicated below: G Service information continued on attached page II. SERVED BY U.S. MAIL OR OVERNIGHT MAIL (indicate method for each person or entity served): On _________________________ I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States Mail, first class, postage prepaid, and/or with an overnight mail service addressed as follow. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page III. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (indicate method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on _______________________ I served the following person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method) by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. _________________________________________________________ Date Type Name _____________________________________ Signature This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2016-1.2 F 2016-1.2 Fee/Expense Application - Page 4 In re CHAPTER _______ Debtor. CASE NUMBER ADDITIONAL SERVICE INFORMATION (if needed): This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2016-1.2