LBR Form 2014-1(g) - 4 AFFIDAVIT OF COUNSEL State of _____________________ } } County of ___________________ } ss: I, _________________________________, being duly sworn, hereby declare under penalty of perjury the following: (Name of Attorney) I am the Attorney named in the Application for Employment and Retention of _______________________________ as Bankruptcy Counsel to the Debtor. OR I am a Partner/Associate of the Law Firm of _______________________________, and I am duly authorized to make this Affidavit on behalf of [Law Firm]. Except as otherwise noted, I have personal knowledge of the matters set forth herein. My mailing address, telephone number, email address and state bar number are: I am an Attorney licensed and in good standing to practice in the State of Ohio and am duly admitted to practice in the United States District Court, Southern District of Ohio. The representations set forth in the Application for Retention and Employment of _____________________________ as Bankruptcy Counsel for the Debtor are true and correct. Neither I [nor Law Firm] have any past or present relationship to the Debtor(s), the Trustee, any creditor or equity security holder of the Debtor(s), except _________________________________. Further, neither I [nor Law Firm] have any connection with the Debtor(s), creditors, or 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, except ______________________________. Neither I [nor Law Firm] hold or represent an interest adverse to the estate. I [and Law Firm] is/are disinterested persons as required by 11 U.S.C. ' 327 and as defined in 11 U.S.C. ' 101(14), except _________________________________. My proposed employment is [and the employment of _________________________________ ] not prohibited by or improper under Fed. R. Bankr. P. 5002. I have not received any compensation herein within one year prior to the filing of the Debtor(s)= petition through the date of the Application, except _________________________________. I declare under penalty of perjury that the foregoing is true and correct. _________________________________ /s/ Name of Attorney Sworn to and subscribed before me by the said _______________________________on this ___ day of ____________, 200_. (Name of Attorney) _________________________________ Notary Public My commission expires: _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com