UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-1(B) In Re: Case No.: Judge: Chapter: _______________________ _______________________ _______________________ CERTIFICATION OF PROFESSIONAL IN SUPPORT OF APPLICATION FOR RETENTION OF PROFESSIONAL I, __________________________________, being of full age, certify as follows: 1. 2. I am seeking authorization to be retained as ____________________________________. My professional credentials include: __________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. I am a member of or associated with the firm of: ________________________________ ______________________________________________________________________________. 4. The proposed arrangement for compensation, including hourly rates, if applicable, is as follows_______________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Pursuant to D.N.J. LBR 2014-3, I request a waiver of the requirements of D.N.J. LBR 2016-1. 5. To the best of my knowledge, after reasonable and diligent investigation, my connection with the debtor(s), creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee, is as follows: American LegalNet, Inc. www.FormsWorkFlow.com None Describe connection:___________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. To the best of my knowledge, after reasonable and diligent investigation, the connection of my firm, its members, shareholders, partners, associates, officers and/or employees with the debtor(s), creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee, is as follows: None Describe Connection: __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. To the best of my knowledge, my firm, its members, shareholders, partners, associates, officers and/or employees and I (check all that apply): do not hold an adverse interest to the estate. do not represent an adverse interest to the estate. are disinterested under 11 U.S.C. § 101(14). do not represent or hold any interest adverse to the debtor or the estate with respect to the matter for which I will be retained under 11 U.S.C. § 327(e). Other. Explain: ______________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. If the professional is an auctioneer, The following are my qualifications and experience with the liquidation or sale of similar property: ____________________________________________________ __________________________________________________________________ __________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com b. The proposed method of calculation of my compensation, including rates and formulas, is: ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Pursuant to D.N.J. 2014-2, I do or do not request a waiver of the requirements of D. N. J. LBR 2016-1. c. The following is an estimate of all costs and expenses, including labor, security, advertising, delivery, mailing, and insurance, for which I will seek reimbursement from the sale proceeds: ________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ d. Have you, or a principal of your firm, been convicted of a criminal offense? No Yes (explain below) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ e. I certify that a surety bond as described in D. N. J. LBR 2014-2(a)(6) is in effect and will remain so through the date of turnover of the auction proceeds. 9. If the professional is an auctioneer, appraiser or realtor, the location and description of the property is as follows: _________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I certify under penalty of perjury that the above information is true. Date: ___________________________ ________________________________ Signature of Professional rev.8/1/15 3 American LegalNet, Inc. www.FormsWorkFlow.com