Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Individual appearing without attorney Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA - **SELECT DIVISION** In re: CASE NO.: DIVISION CHAPTER: SELECT CHAPTER APPLICATION FOR PAYMENT OF: INTERIM FEES AND/OR EXPENSES (11 U.S.C. § 331) FINAL FEES AND/OR EXPENSES (11 U.S.C. § 330) DATE: TIME: COURTROOM: PLACE: Debtor(s). 1. Name of Applicant (specify): 2. Type of services rendered: Attorney for (specify): a. 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: This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 1 F 2016-1.2.APP.PAYMENT.FEES 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: $ 7. Summary of Requested Fees: (attach detailed supporting documentation to this Application) Professional Person's Name a. b. c. d. e. f. g. Continued on attached page Hourly Rate $ $ $ $ $ $ X X X X X X X Total Hours this Person = = = = = = = $ $ $ $ $ $ Total Fees this Person 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): $ This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 2 F 2016-1.2.APP.PAYMENT.FEES 12. Summary of Requested Expense Reimbursement: (attach detailed supporting documentation to this Application) Type of Expense a. b. c. d. e. f. g. Continued on Attached Page Reimbursement Requested this Application $ $ $ $ $ $ 13. TOTAL EXPENSE REIMBURSEMENT REQUESTED THIS APPLICATION: $ 14. Applicant submits the following in support of the Application herein pursuant to LBR 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 that the foregoing Application and all attached supporting documentation are true and correct and accurately reflect services rendered and expenses incurred. I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date Printed Name Signature This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 3 F 2016-1.2.APP.PAYMENT.FEES 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 entitled: APPLICATION FOR PAYMENT OF INTERIM (11 U.S.C. § 331)/FINAL FEES AND/OR EXPENSES (11 U.S.C. § 330) 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 stated below: 1. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (NEF): Pursuant to controlling General Orders and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On (date) , I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following persons are on the Electronic Mail Notice List to receive NEF transmission at the email addresses stated below: Service information continued on attached page 2. SERVED BY UNITED STATES MAIL: , I served the following persons and/or entities at the last known addresses in this bankruptcy On (date) 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 addressed 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. Service information continued on attached page 3. SERVED BY PERSONAL DELIVERY, OVERNIGHT MAIL, FACSIMILE TRANSMISSION OR EMAIL (state method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on (date) , I served the following persons and/or entities by personal delivery, overnight mail service, 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 personal delivery on, or overnight mail to, the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date Printed Name Signature This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 4 F 2016-1.2.APP.PAYMENT.FEES