LBR Form 2014-1(g) - 3 CHAPTER 11 FORM UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF OHIO _____________ DIVISION In re: Case No: Chapter Debtor(s) Judge APPLICATION FOR EMPLOYMENT AND RETENTION OF __________________________ AS BANKRUPTCY COUNSEL TO THE DEBTOR Now comes (Name of Debtor) (AApplicant@), and hereby requests, pursuant to 11 U.S.C. ' 327(a), Fed. R. Bankr. P 2014, and LBR 2014-1, that the Court authorize the employment of (Name of Attorney [and name of Law Firm]) as bankruptcy counsel to the Debtor. In support of his/her Application, Applicant respectfully represents the following: _____ Applicant is the Debtor in the captioned case. _____ Applicant wishes to employ (Name of Attorney/Law Firm) to represent him/her/it in this case. _____ (Name of Attorney(s)) are members or associates of (Name of the Attorney/Law Firm). Each is an attorney duly admitted to practice in this court and is in good standing. _____ Applicant has selected (Name of Attorney/Law Firm) for the reason that he/she/it has had significant experience in bankruptcy and reorganization matters and is well-qualified to represent the estate. _____ The professional services to be rendered by (Name of Attorney/Law Firm) shall include, but are not limited to, the following: (a) to advise the Debtor with respect to his/her/its rights, powers and duties in this case; (b) to advise and assist the Debtor in the preparation of its petition, schedules, and statement of financial affairs; (c) to assist and advise the Debtor in connection with the administration of this case; (d) to analyze the claims of the creditors in this case, and negotiate with such creditors; (e) to investigate the acts, conduct, assets, rights, liabilities and financial condition of the Debtor and the Debtor=s business; (f) to advise and negotiate with respect to the sale of any or all assets of the Debtor; (g) to investigate, file and prosecute litigation of behalf of the Debtor; (h) to propose a plan of reorganization; (I) to appear and represent the Debtor at hearings, conferences, and other proceedings; (j) to prepare and/or review motions, applications, orders, and other filings filed with the Court; (k) to institute or continue any appropriate proceedings to recover assets of the estate; (l) [other services as required by the particular case, e.g., labor relations, worker=s compensation, ERISA, environmental matters, etc.]; and (m) to perform any and all such other legal services as may be required that are in the best interest of the estate or its creditors. _____ (Name of Attorney/Law Firm) does not hold or represent any interest adverse to the estate as required by 11 U.S.C. ' 327(a), except as set forth in the Affidavit of Counsel attached hereto as Exhibit ____. American LegalNet, Inc. www.FormsWorkFlow.com _____ (Name of Attorney/Law Firm) is a disinterested person as required by 11 U.S.C. ' 327 and as defined in 11 U.S.C. ' 101(14). _____ (Name of Attorney/Law Firm) proposes to perform legal services in connection with his/her/its employment on an hourly basis, at his/her/its usual and customary hourly rate, plus reimbursement of reasonable and necessary expenses. Attorney=s/Law Firm=s current hourly rate [is: ______$][ranges from $______ to $_____ for partners, $______ to $______ for associates, and $______ to $______ for paraprofessionals.] These hourly rates are subject to periodic adjustments. Notice of any such adjustments shall be filed with the Court within 30 days of the effective date of the adjustment. _____ (Name of Attorney/Law Firm) has been paid $______ in fees and/or expenses from the Debtor from a period of one year prior to the filing of the Debtor=s petition through the date of this Application. The fees were paid on [Date(s)]. The source of the fees was ___________________________. OR The Attached Exhibit ____ contains a listing of the statement dates, statement amounts, payment dates and amounts of fees paid within one year of the petition date. _____ (Name of Attorney/Law Firm) will submit interim and final applications for compensation and reimbursement of expenses in accordance with the Federal Rules of Bankruptcy Procedure, the Local Bankruptcy Rules, and such other and further orders as the Court may enter. _____ (Name of Attorney/Law Firm) has received no funds from the Debtor or the Debtor=s estate from a period of one year prior to the filing of the Debtor=s petition through the date of this Application. _____ (Name of Attorney/Law Firm) received a retainer in the amount of $______ from the Debtor within one year prior to the filing of the petition through the date of this Application. The retainer was paid on (Date(s)). The source of the retainer was ____________________________. The retainer has been placed in the Firm=s Trust Account pending further order of the Court permitting the application of funds from the retainer to payment of fees and reimbursement of expenses. OR $______ of the retainer amount has been applied by [Law Firm] to pre-petition services rendered in contemplation of the bankruptcy filing. A listing of the services rendered and the amounts applied to these services from the retainer is contained in attached Exhibit ____. The remainder of the retainer remains in the Law Firm=s Trust Account pending further order of the Court. _____ ( Name of Attorney ) has received or sought no retainer from the Debtor within one year prior to the filing of the petition through the date of this Application. _____ To the best of (Applicant=s) knowledge, (Name of Attorney/Law Firm) has no connections 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 [except as set forth on the Attached Exhibit ___]. _____ The proposed employment of (Name of Attorney/Law Firm) is not prohibited by or improper under Fed. R. Bank. P. 5002. WHEREFORE, Applicant moves for an Order of this Court authorizing the retention and employment, as of the date of this Application, of (Name of Attorney/Law Firm) as attorney(s) for the estate, to be compensated as set forth above. Respectfully submitted, _________________________________ /s/ Name of Debtor _________________________________ Name of Signing Officer Title American LegalNet, Inc. www.FormsWorkFlow.com