C-13-12(e) (04/12) UNITED STATES BANKRUPTCY COURT M IDDLE DISTRICT OF NORTH CAROLINA In Re: ) ) ) ) ) ) ) ) ) ) APPLICATION FOR BASE FEE ELECTRONICALLY FILED CHAPTER 13 Case No: Debtor(s) NO W fees. CO M ES the undersigned attorney for the Debtor(s), and m akes application for paym ent of attorney The undersigned prepared proceedings in this m atter. the petition, schedules and plan and has represented the Debtor(s) in all The undersigned believes that $___________ is a fair and reasonable fee for services to the Debtor(s) and has received from the Debtor(s) $___________, with $_____________ rem aining to be paid. No agreem ents have been m ade and no understanding exists undersigned and the Trustee or between the undersigned and the Debtor(s). for a division of fees between the No com pensation has been paid or prom ised and no property has been transferred or prom ised to the undersigned as com pensation for services rendered or to be rendered in connection with this case, other than as set forth herein. Except as specially noted hereon, the undersigned has neither shared nor agreed to share com pensation with any other person other than the m em bers or regular associates of the law firm with which the undersigned is associated. W HEREFORE, the undersigned prays that an Order be entered allowing a fee of $___________, with the balance of $_____________ to be paid through the disbursem ents by the Trustee. Date: Attorney for Debtor(s) State Bar Code No. CERTIFICATE OF MAILING This is to certify that I have this day served a copy of the Application For Base Fee on the Chapter 13 Trustee. Date: American LegalNet, Inc. www.FormsWorkFlow.com