LOCAL FORM 2016-1Revised UNITED STATES BANKRUPTCY COURTDISTRICT OF MINNESOTAIn re:Case No.Debtors.APPLICATION FOR COMPENSATION AND REIMBURSEMENT OF EXPENSES BY ATTORNEY FOR DEBTOR(S) IN CHAPTER 13 CASEThe undersigned applicant, pursuant to Local Rule 2016-1(d), states that:1.The applicant is the attorney for the Debtor(s).2.The status of the case is as follows: 221A plan was confirmed on ; or221No plan has been confirmed and the case is pending; or The trustee has funds on hand in the amount of $ .3.Applicant seeks allowance of fees and reimbursement of expenses as follows: Fees: Motion to value$ Other pre-confirmation services$ Post-confirmation services$ Expenses: Filing Fee$ Copies (#) @ $. =$ Postage (#) @ $ . =$ Other (Itemize)$ Total Expenses:$ Total Fees and Expenses:$ (collectively, 223Requested Fees and Expenses.224) If the requested expenses include costs in addition tothe expenses listed above, an itemization is attached to this application.Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com LOCAL FORM 2016-1Revised UNITED STATES BANKRUPTCY COURTDISTRICT OF MINNESOTAIn re:Case No.Debtor(s).ORDERThis case came before the Court on the Application for Compensation and Reimbursementof Expenses by Attorney for Debtor(s) in Chapter 13 Case. Appearances, if any, were noted on therecord. Based on the application and the file, record and proceedings herein, IT IS ORDERED: Applicant is awarded $ , the unpaid balance stated in paragraph 5 of theapplication for compensation and/or reimbursement. BY THE COURT: Dated: U.S. Bankruptcy Judge Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com