LBR Form 2014-1(g) - 1 UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF OHIO _____________ DIVISION In re: Case No: Chapter Debtor(s) Judge APPLICATION OF TRUSTEE TO EMPLOY SPECIAL COUNSEL Now comes (Name of Trustee) (AApplicant@), the Trustee herein, and hereby requests, pursuant to 11 U.S.C. ' 327(e), 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 special counsel for the estate. In support of his/her Application, Applicant respectfully represents the following: _____ Applicant has been appointed [interim/standing] trustee with respect to the estate herein, has qualified and is acting as such trustee. _____ Applicant wishes to employ (Name of Attorney [and the Name of Law Firm]) to represent him/her in this case. _____ (Name of Attorney) is an attorney duly admitted to practice in [specify jurisdiction of admission] and is in good standing. _____ Applicant has selected (Name of Attorney) for the reason that he/she has had significant experience in (personal injury litigation, probate law, medical malpractice law, employment discrimination law, etc.), and is well-qualified to represent the estate. _____ The professional services to be rendered by (Name of Attorney) shall include, but are not limited to, the following: (a) to institute or continue any appropriate proceedings to recover assets of the estate; (b) to litigate or otherwise resolve issues regarding property of the estate; and (c) to perform such other legal services as may be required that are in the best interest of the estate or its creditors. Specifically, Applicant seeks to employ special counsel to [insert specific reason for retention of special counsel.] _____ (Name of Attorney) does not represent or hold any interest adverse to the estate with respect to the matter on which he/she is to be employed. _____ (Name of Attorney) proposes to perform legal services for the trustee in connection with his/her employment [at his/her customary hourly rate of $______ plus reasonable expenses] OR [on a contingency fee basis, with counsel to receive ___% of any amounts recovered either through judgment or by settlement, plus reasonable expenses] OR [on a fixed or percentage fee basis.] _____ (Name of Attorney) 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 ____________________________. American LegalNet, Inc. www.FormsWorkFlow.com _____ (Name of Attorney) 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) has received or sought 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 ____________________________. _____ (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 (Name of Attorney)=s knowledge, he/she 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 (Name of Attorney) has previously represented debtor in connection with the matter that is the subject of this application; OR (Name of Attorney) has previously represented the Debtor in connection with the underlying bankruptcy case; OR (Name of Attorney) has previously represented the Trustee in connection with matters unrelated to the subject of this application; OR any other connection.] _____ The proposed employment of (Name of Attorney) 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 [and Law Firm]) as special counsel for the estate, to be compensated as set forth above. Respectfully submitted, ___________________________________ /s/ Name of Trustee American LegalNet, Inc. www.FormsWorkFlow.com