Form 20161(a)(1)(A) UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF OHIO _____________ DIVISION In re: Case No: Chapter Debtor(s) Judge INTERIM APPLICATION OF ____________________________ FOR ALLOWANCE OF COMPENSATION AND REIMBURSEMENT OF EXPENSES FOR THE PERIOD ___________________ THROUGH ___________________ _____________________________[Name of Applicant], in accordance with Rule 2016 applies under 330 and 331 of th e Code for an award of compensation and reimbursement of actual, necessary expenses and represents: PART A: PRELIMINARY STATEMENT 1. Applicant is [professional capacity] for [entity represented or engaged by]. 2. All services rendered and expenses incurred for which compensation or reimbursement is requested were performed or incurred for or on behalf of [entity represented or engaged by]. 3. The services described in this Application are actual, necessary services and the compensation requested for those services is reasonable. 4. The expenses described in this Application are actual, necessary expense s. Additional numbered paragraphs may be used by the Applicant to set forth other statements or information.] 97 American LegalNet, Inc. www.USCourtForms.com>>>> 2PART B: GENERAL INFORMATION 1. Period xx/xx/xx to xx/xx/xx Final Application ________ Interim Application ________ Requested Fees $____________ Expenses $____________ Total $____________ 2. General Information a. Date case filed: xx/xx/xx b. Date application to approve employment filed: xx/xx/xx c. Date employmnt approved: xx/xx/xx e d. First date services rendered in the case: xx/xx/xx e. Compensation request is under 330: _____ Yes _____ No If other statutory basis, specify: ________ f. Any fees awarded will be paid from the estate: ______ Yes ______ No If no, state the source of payment of any fee that is awarded. _________________________________________________ 98 American LegalNet, Inc. www.USCourtForms.com>>>> 3 g. This application is for a period less than 120 days after the filing of the case or less than 120 days after the end of the period of the last application. _____ Yes _____ No If yes, state date and terms of court order allowing filing at shortened intervals. Order date: xx/xx/xx Terms, if any,_______________________________________________________________________ _____ ________________________________________________________________________ _______________ 3. Prior Applications First Application Period xx/xx/xx to xx/xx/xx Date of Order xx/xx/xx Requested Allowed P aid D ue Fees $________ $________ $________ $________ Expenses $________ $________ $________ $________ Second Application Period xx/xx/xx to xx/xx/xx Date of Order xx/xx/xx Requested Allowed P aid D ue Fees $________ $________ $________ $________ Expenses $________ $________ $________ $________ Grand Totals: $________ $________ $________ $________ 99 American LegalNet, Inc. www.USCourtForms.com>>>> 4 4. Professionals/Paraprofessionals Billing for Current Period Name H our s Billing Rate T otal Grand Total: $______________ 5. Billing Rates a. Are any of the billing rates different than the billing rates set forth in your last application? _____ Yes _____ No b. If yes, indicate whose billings rates are different and explain why? ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ PART C: BILLING SUMMARY 1. Description of Services. Provide adequate detail appropriate for the amount of time billed and the nature and variety of the services rendered. 2. Detail of Hours Expended. Set forth in list form or attach a list that shows the name of the professional or paraprofessional, date, activity, and time expended. The list may be organized in either of two ways. (a) By each professional or paraprofessional in chronological order for the application period; or (b) By day in chronological order showing all professionals or paraprofessio nals that billed time on a particular day during the application period. 100 American LegalNet, Inc. www.USCourtForms.com>>>> 5 PART D: EXPENSE SUMMARY Set forth in list form or attach a list that shows the type of expenses for which reimbursement is sought. (a) Are the amounts of the expenses calculated using the applicants in-house actual cost or the actual amount billed by a third party provider? _____ Yes _____ No (b) If no, identify those expenses that were not calculated using the applicants in-house actual cost or the actual amount billed by a third party provider and explain how the amount of the expense is calculated. ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ WHEREFORE, Applicant requests an award of $ ___________ in compensation and of $ ____________ in reimbursement of actual, necessary expenses. Dated:_______________ ___________________________________ 101 American LegalNet, Inc. www.USCourtForms.com