2004 USBC, District of Maine Form B203 UNITED STATES BANKRUPTCY COURT DISTRICT OF MAINE In re [Debtor] [Joint Debtor] Case Number: DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR Debtor(s) 1. Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) and that compensation paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows: For legal services, I have agreed to accept…………………………………………………….$ __________ Prior to the filing of this statement I have received………………………………. $__________ Balance Due…………….………………………………………………………….$ __________ 2. The source of the compensation paid to me was: Debtor 3. The source of compensation to be paid to me is: Debtor 4. Other (specify) Other (specify) I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm. I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is attached. 5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including: a. Analysis of the debtor’s financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy; b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required; c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof; d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters; e. Other provisions as needed: American LegalNet, Inc. www.FormsWorkFlow.com Form B203 - Continued 2004 USBC, District of Maine 6. By agreement with the debtor(s), the above-disclosed fee does not include the following services: CERTIFICATION I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s) in this bankruptcy proceeding. _________________________ Date _____________________________________________ Signature of Attorney _____________________________________________ Name of Law Firm American LegalNet, Inc. www.FormsWorkFlow.com