UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY In re Case No.: Debtor(s). ________________________________ ____________________ Judge: ____________________ CERTIFICATION OF DEBTOR’S COUNSEL SUPPORTING SUPPLEMENTAL CHAPTER 13 FEE For time incurred in Chapter 13 cases prior to August 1, 2006, for which supplemental fees are sought, you must utilize the alternate version of Local Form 13 as has been designated for that purpose on the Court’s web site: www.njb.uscourts.gov. __________________________________, Esquire, hereby certifies as follows: 1. I represented the debtor in connection with the following proceeding(s) in debtor’s chapter 13 case: STANDARD FEES ____ Prosecution of motion on behalf of debtor. Nature of motion: $500.00 ____________________________ ____________________________ Hearing date(s): ____________________________ ____________________________ ____ Defense of motion on behalf of debtor (Including filing Objection to Creditor’s or Trustee’s Certification of Default). Nature of motion: $400.00 ____________________________ ____________________________ Hearing date(s): ____________________________ ____________________________ American LegalNet, Inc. www.FormsWorkflow.com ____ Additional court appearance(s). (Not to exceed three). Purpose: $100.00 ____________________________ ____________________________ Hearing date(s): ____________________________ ____________________________ ____ Filing and appearance on a modified Chapter 13 Plan. $300.00 ____ Preparation of Wage Order $100.00 ____ Preparation and filing of Amendments to Schedules D, E, F or List of Creditors $100.00 ____ Preparation and filing of other amended schedules $100.00 ____ Preparation and filing of Application for Retention of Professional $200.00 ____ Preparation and filing of Notice of Sale or Settlement of Controversy $100.00 NON-STANDARD FEES Do not combine standard and non-standard fees for the same motion or service. If you believe the standard fee is inappropriate for services in a particular instance, you must request only nonstandard fees for that particular service. Describe non-standard services in detail, and attach a time detail (including applicable hourly rates) as Exhibit A:________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkflow.com Describe non-standard expenses in detail: ______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. To date, in this case: I have applied for fees (including original retainer) in the amount of: __________ To date, I have received: __________ 3. I seek compensation for services rendered in the amount of $ _____________ payable: ____ through the chapter 13 plan as an administrative priority. ____ outside the plan. ‘ This allowance will not impact on plan payments. ‘ 4. This allowance will impact on plan payments. Present plan: $ ____________ per month for ____________ months. Proposed Plan: $ ____________ per month for ____________ months. I certify that I have not filed any fee application within the last 90 days. I certify under penalty of perjury that the foregoing is true and correct. Dated: _______________________ ______________________________________ Signature of applicant Local Form 13.rev.8/1/06.jml 3 American LegalNet, Inc. www.FormsWorkflow.com