LBR Form 2016-1(b) UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF OHIO ____________ DIVISION AT ____________ In re: Case No: Chapter 13 Debtor(s) Judge DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR AND APPLICATION FOR ALLOWANCE OF FEES IN CHAPTER 13 CASE I. 1. Disclosure Pursuant to 11 U.S.C. § 329(a) and Fed. R. Bankr. P. 2016(b), I certify that I am the attorney for the above-named debtor(s) and that compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows: For legal services I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . . $___________ Prior to the filing of this statement I have received . . . . . . . . . . . . . . . . . . $___________ Balance due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________ 2. The source of the compensation paid to me was: Debtor 3. The source of compensation to be paid to me is: Debtor 4. Other (specify) Other (specify) I have not agreed to share the above-disclosed compensation with any other persons unless they are members and/or associates of my law firm. I have agreed to share the above-disclosed compensation with another person or persons who are not members or associates of my law firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is attached. American LegalNet, Inc. www.FormsWorkFlow.com II. 5. Application I hereby apply for an allowance of fees in the amount set forth above. I understand and agree that the Court may approve, without itemization, an allowance of fees not to exceed $3,500, for rendering the legal services set forth below. If I seek payment of fees in excess of $3,500, I will file a separate application that sets forth the total amount of the fee requested, and that includes an itemization of all legal services performed, the amount and itemization of any expenses for which reimbursement is sought, the identification and hourly billing rate of any attorney, paralegal, or other professional person for whom fees are sought, and the actual time spend by the attorney, paralegal, or other professional person for whom fees are sought. a. Initial client interview, preparation and signing of any retainer or representation agreement, analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether, and under what chapter, to file a petition in bankruptcy; b. Advising the debtor concerning his or her obligations and duties pursuant to the Code, the Rules, the Local Rules, applicable court orders, and provisions of his or her chapter 13 plan; c. Preparation and filing of any document required by § 521 of the Code, including Official Form 122C-1 and Official Form 122C-2 (if applicable), the petition, schedules, statement of financial affairs and any amendments thereto that may be required; d. Preparation and filing of the chapter 13 plan, and any preconfirmation amendments thereto that may be required; e. Preparation and filing of payroll orders and amended payroll orders, except amended payroll orders prepared in connection with the modification of a plan or the temporary suspension of payments; f. Representation of the debtor at the § 341 meeting of creditors and confirmation hearing, and at any adjournments thereof; g. Filing of address changes for the debtor; h. Review of claims; i. Review of notice of intention to pay claims; j. Preparation and filing of objections to non-real estate and non-tax claims, exclusive of any hearings; k. Preparation and filing of first motion to suspend or temporarily reduce plan payments; l. Representation of the debtor in addressing any routine tax return or tax refund inquiries by the trustee, exclusive of any motion, objection, or hearing; m. Filing of a notice of final cure payment, when filed by the debtor, exclusive of any hearings; n. Preparation and filing of debtor's certification regarding issuance of discharge order; o. Routine phone calls and questions; p. File maintenance and routine case management; and q. Any other duty as required by local decision or policy. 6. By agreement with the debtor(s), the above-disclosed fee does not include the following services: ____________________ Date ___________________________________ American LegalNet, Inc. www.FormsWorkFlow.com