L.B.F . 2016 - 3.4 (12/1 8 ) Page 1 Fill in this information to identify your case UNITED STATES BANKRUPTCY COURT DISTRICT OF COLORADO Debtor 1 : Case #: First Name Middle Name Last Name 13 Debtor 2: Chapter : First Name Middle Name Last Name Local Bankruptcy Form 2016 - 3. 4 Chapter 13 Supplemental Fee Application Complete applicable sections and check applicable boxes. Pursuant to 11 U.S.C. 247 330, Applicant, [law firm] , attorney for the d ebtor, requests allowance of the following fees and reimbursement of out - of - pocket expenses incurred for all reasonably necessary and appropriate services rendered up to the date of confirmation as follows: 1. Total fees approved in prior application or through PRFA procedure : $ 2. Total expenses approved in prior application or through PRFA procedure : + $ 3. Total fees and expenses previously approved by the Court (add line 1 and line 2) = $ 4. Total r equested previously in this application $ 5. Total e xpenses requested in this application + $ 6. Total supplemental fees and expenses requested ( add line 4 and line 5) = $ 7. Total fees and expenses requested or approved in all application s (add line 3 and line 6) = $ 8. Amount paid prior to filing (exclusive of the filing fee) $ 9. Net amount of fees and expenses to be paid throu gh confirmed plan not to exceed amount funded by the plan (Line 7 less Line 8) = $ Amount of fee s Applicant agreed to with d ebtor for performing services to represent the debtor in this case: a mount disclosed in 2016(b) disclosure $ a mount disclosed in amended 2016(b) disclosure $ (a) This agreed upon fee represents: (b) [ amount] /hour; the rate for associate attorney services is $ [amount] / hour; and the rate for paralegal services is $ [amount] /hour. Part 1 Summary Part 2 Fees a flat fee for all services in the case ; h ourly charges based upon time spent; and/or other fee arrangement based upon: [specify terms] . American LegalNet, Inc. www.FormsWorkFlow.com L.B.F . 2016 - 3.4 (12/1 8 ) Page 2 Amount of Expenses Incurred: Copies: [number of copies] @ [amount] /copy $ Postage: $ Legal research : $ Facsimile: $ Other (specify) : $ Total: $ Applicant Certifies/Attests that: I have performed all reasonably necessary and appropriate services during the pendency of the entire case consistent with L.B.R. 9010 - 1, and previously obtained approval of fees and/or costs under the PRFA procedure or LFFA procedure as set forth in L.B.R. 2016 - 3. I am requesting a supplemental fee for services rendered post - confirmation which exceeds the previously approved fees under the PRFA or LFFA. Attached to this Application are: a. A narrative describing the services rendered post - confirmation in the case and the reasons why the applicant seeks a fee in excess of the fees previously approved by the Court under the PRFA or LFFA, such as results achieved, difficulties encountered or an y other unique aspects of the case and discussing the standards of 11 U.S.C. 247 330(a); b. Detailed time records describing all individual services which include: i. the time spent for each service rendered, broken out in tenths of an hour; ii. the hourly rate for ea paralegals); iii. the charge for each service rendered; and iv. such other and further information as the Applicant believes is necessary to support allowance of the fee purs uant to 11 U.S.C. 247 330(a). Dated: By: Signature of Attorney Bar Number: Mailing A ddress : Telephone number : Facsimile number : E - mail address : Part 3 Expenses Part 4 Part 5 Application Attachments Part 6 Signature of s Attorney American LegalNet, Inc. www.FormsWorkFlow.com