UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION IN RE: Name of Debtor(s), Debtor(s). ) Case No. ________ ) ) CHAPTER 13 ) ) VERIFICATION The last day for non-governmental creditors to file claims in this case was [date]. [name of creditor], a creditor secured by Debtor's(s') real estate, failed to file a proof of claim by this date. I filed a proof of claim on behalf of [name of creditor] on [date], a date no more than 30 days after the last date for nongovernmental creditors to file claims in this case. Dated: __________ _________ _____________________________ Attorney Name, Fed. and State Bar No. Attorney for Debtor(s) Address City, State, Zip Code Phone, Fax, E-mail ORDER Based on the recitations in the above verification, Debtor's(s') attorney of record is hereby awarded an additional $125 in fees, to be paid by the Trustee under the terms of the confirmed Chapter 13 plan. Dated: __________ _____________________________ United States Bankruptcy Judge Copies to: John V. LaBarge, Jr. Standing Chapter 13 Trustee PO Box 430908 St. Louis, MO 63143 Debtor(s) Address City, State, Zip Code Creditor Address City, State, Zip Code Rev. 1/2011 Debtor's(s') Attorney Attorney for Debtor(s) Address City, State, Zip Code U.S. Trustee Office of the U.S. Trustee 111 S. 10th Street Suite 6353 St. Louis, MO 63102 American LegalNet, Inc. www.FormsWorkFlow.com