UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY D.N.J. LBR 2016-1, FEE APPLICATION COVER SHEET IN RE: _________________________ APPLICANT: __________________________ CASE NO.: _____________________ CLIENT: CHAPTER: _____________________ CASE FILED: __________________________ __________________________ COMPLETION AND SIGNING OF THIS FORM CONSTITUTES A CERTIFICATION UNDER PENALTY OF PERJURY, PURSUANT TO 28 U.S.C. SECTION 1746. RETENTION ORDER(S) ATTACHED SECTION 1 FEE SUMMARY INTERIM FEE APPLICATION NO. OR TOTAL PREVIOUS FEE REQUESTED: TOTAL FEES ALLOWED TO DATE: TOTAL RETAINER (IF APPLICABLE) TOTAL HOLDBACK (IF APPLICABLE) TOTAL RECEIVED BY APPLICANT NAME OF PROFESSIONAL & TITLE FINAL FEE APPLICATION FEES EXPENSES $ $ $ $ $ $ $ $ $ $ YEAR ADMITTED (OR YEARS OF PROFESSIONAL SERVICE) HOURS RATE FEE 1. 2. 3. 4. 5. 6. 7. FEE TOTALS - PAGE 2 DISBURSEMENTS TOTALS - PAGE 3 TOTAL FEE APPLICATION __________________ __________________ __________________ Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com SECTION II SUMMARY OF SERVICES HOURS FEE SERVICES RENDERED a) Asset Analysis and Recovery b) Asset Disposition c) Business Operations d) Case Administration e) Claims Administration and Objections f) Employee Benefits/Pensions g) Fee/Employment Applications h) Fee/Employment Objections i) Financing j) Litigation (Other than Avoidance Action Litigation) k) Avoidance Action Litigation l) Meetings of Creditors m) Plan and Disclosure Statement n) Relief from Stay Proceedings o) Regulatory Compliance p) Travel q) Accounting/Auditing r) Business Analysis s) Corporate Finance and Valuation t) Data Analysis u) Litigation Consulting v) Reconstruction Accounting w) Tax Issues x) Other (specify category) SERVICES TOTAL: American LegalNet, Inc. www.FormsWorkflow.com Page 2 of 4 SECTION III SUMMARY OF DISBURSEMENTS DISBURSEMENTS AMOUNT a) Computer Assisted Legal Research b) Facsimile (with rates) No. of Pages Rate per Page (Max. $1.00/pg.) c) Long Distance Telephone d) In-House Reproduction Rate per Page No. of Pages (Max. .20¢pg.) e) Outside Reproduction f) Outside Research g) Filing/Court Fees h) Court Reporting i) Travel j) Courier & Express Carriers (e.g., Federal Express) k) Postage l) Other (Explain) DISBURSEMENTS TOTAL: American LegalNet, Inc. www.FormsWorkflow.com Page 3 of 4 SECTION IV CASE HISTORY (NOTE: Items 3 - 6 are not applicable to applications under 11 U.S.C. § 506) (1) DATE CASE FILED: (2) CHAPTER UNDER WHICH CASE WAS COMMENCED: (3) DATE OF RETENTION: (ANNEX COPY OF ORDER(S)) IF LIMIT ON NUMBERS OF HOURS OR OTHER LIMITATIONS TO RETENTION, SET FORTH: (4) SUMMARIZE IN BRIEF THE BENEFITS TO THE ESTATE AND ATTACH SUPPLEMENTS AS NEEDED: (5) ANTICIPATED DISTRIBUTION TO CREDITORS: (A) ADMINISTRATION EXPENSES: (B) SECURED CREDITORS (C) PRIORITY CREDITORS (D) GENERAL UNSECURED CREDITORS: (6) FINAL DISPOSITION OF CASE AND PERCENTAGE OF DIVIDEND PAID TO CREDITOR (IF APPLICABLE): I certify under penalty of perjury that the foregoing is true and correct. ______________________________________ SIGNATURE OF APPLICANT DATE Local Form 3 -rev. 8/1/06.jml Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com