B 203 (12/94) United States Bankruptcy Court _______________ District Of _______________ In re Case No. ___________ Chapter _________ Debtor DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR 1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the atto rn ey for the abovenamed debtor(s) and that compensation paid to me w ithin one year before the filing of the petition in bankruptcy, o r agreed to be paid to me, fo r services rendered or to be rendered on behalf o f the debto r(s) in contemplation of or in connection w ith the bankruptcy case is as follow s: For legal services, I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ Prior to the fi ling of this statem ent I have recei ved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ Balance D ue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ 2. The source of the compensati on paid to me w as: D ebtor O ther (specify) 3. The source of compensati on to be paid to me is: D ebtor 4. O ther (specify) I have not agreed to share the above-disclosed compensation w ith any other person unl ess they are members and associates of my law firm. I have agreed to share the above-disclosed compensation w ith a other person or persons w ho are not members or associates of my law firm. A copy of the agreement, together w ith a list of the names of the people sharing in the compensation, is attached. 5. In return for the above-di sclo sed fee, I have agreed to render legal service for all aspects of the bankruptcy case, incl uding: a. Analysis of the debtor' s fi nancial situati on, and renderi ng advice to the debtor i n determining w hether to file a petiti on in bankruptcy; b. Preparation and filing of any petition, schedules, statements of affairs and plan w hich may be required; c. Representati on of the debtor at the meeti ng of cred itors and confi rm ati on heari ng, and any adj ourn ed hearings thereof; American LegalNet, Inc. www.USCourtForms.com DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR (Continued) d. Representation of the debtor in adversary proceedin gs and other contested bankruptcy matters; e. [Other provisions as needed] 6. By agreem ent w ith the debtor(s), the above-discl osed fee does not i ncl ude the follow ing services: CERTIFICATIO N I certify that the foregoing is a complete statement of any agreement or arrangement for paym ent to me for representati on of the debtor(s) in this bankru ptcy p ro ceedings. ___________________________ Date ___________________________________________________ Signature of Attorney _____________________________________________________________ Name of law firm American LegalNet, Inc. www.USCourtForms.com