IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor : : : : : : : : : : : Bankruptcy No. Chapter Movant v. Related to Document No. Hearing Date and Time: Respondent (if none, then "No Respondent") SUMMARY COVER SHEET FOR FEE APPLICATIONS IN CHAPTER 11 AND CHAPTER 15 1. Your applicant was appointed on _______________________________________. (Attach a copy of the order approving appointment.) Your applicant represents _______________________________________. The total amount of the compensation requested is $___________________________ for the period from _________________________________________ to _________________________________________. The compensation is _______________________________________. (State whether interim or final compensation.) A retainer of $_______________________ was paid on _______________________________________. The amount of compensation previously requested is $________________________________________. The amount of compensation previously approved is $________________________________________. The amount of compensation previously paid is $_______________________________________. The total amount of expenses for which reimbursement is sought is $________________________ and is for the period from _________________________________ to _________________________________. The amount of expenses previously requested is $____________________________________________. The amount of expenses previously approved is $____________________________________________. The amount of expenses previously paid is $________________________________________________. The blended hourly rate for this application is $______________________________________________. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. PAWB Local Form 9 (07/13) Page 1of 7 American LegalNet, Inc. www.FormsWorkFlow.com 14. Other factors bearing on fee application: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ DATE: ____________________ By: _____________________________________________ Signature _____________________________________________ Typed Name _____________________________________________ Address _____________________________________________ Phone No. _____________________________________________ List Bar I.D. and State of Admission PAWB Local Form 9 (07/13) Page 2of 7 American LegalNet, Inc. www.FormsWorkFlow.com APPENDIX EXAMPLE OF CATEGORY LISTING OF TIME AND SERVICES PURSUANT TO W.PA.LBR 2016-1(c)(5)(A) IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor : : : : : : : : : : : Bankruptcy No. Chapter Movant v. Related to Document No. Hearing Date and Time: Respondent (if none, then "No Respondent") PART "A" Category Listing of time and services or tasks by category on behalf of Acme Shoe Company, Debtor, during the period from May 1, 1985 to the closing of the case. CATEGORY 1. - Sale of real estate at 320 Grant Avenue, Pittsburgh, PA to Jones Company for $____________________ including negotiations with purchaser, drafting Agreement of Sale, lien search, preparation and filing of Motion and Order for sale, hearing on sale and closing on sale and preparation and filing of report of sale. After payment of all liens and expenses of sale the estate netted $____________________. DATE 5/1/85 ATTY RB DESCRIPTION OF SERVICE Conference with Jones Company representatives re: potential purchase of 320 Grant Avenue Preparation of Agreement of Sale for 320 Grant Avenue HOURS 5/3/85 RB TOTAL IN CATEGORY 1: CATEGORY 2. - Distribution to Creditors per Order of August 14, 2002, including preparation and filing of Motion, obtaining Order of Court and making the distribution of $____________________ to priority creditors and $____________________ as a ______________% distribution to Class 4 general creditors. DATE 9/17/85 9/18/85 ATTY JS JS DESCRIPTION OF SERVICE Review & Sign Distribution Checks Covering letters to all creditors, Anderson, Wagner, Bernstein & Debtor re the distribution HOURS TOTAL IN CATEGORY 2: PAWB Local Form 9 (07/13) Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com CATEGORY 3. - Tax returns and tax refund including arranging for filing of final returns, numerous calls and letters to Pennsylvania Department of Revenue resulting in tax refund of $12,435.04. 5/02/85 JS Telephone Call: Virginia Vatz of Pa. Dept. of Revenue re tax refund Letter: PA Dept. of Revenue re status of tax returns 5/04/85 JS TOTAL IN CATEGORY 3: TOTAL TIME IN ALL CATEGORIES: DISBURSEMENTS 6/24/85 8/23/85 JS JS Copy Expense Copy Expense and postage on distribution TOTAL DISBURSEMENTS: BILLING SUMMARY JS RB Hrs. Hrs. Min. Min. $135.00 $125.00 $ $ $ CLIENT TOTAL CURRENT BILLING: CURRENT EXPENSES: TOTAL AMOUNT DUE: $ PAWB Local Form 9 (07/13) Page 4of 7 American LegalNet, Inc. www.FormsWorkFlow.com EXAMPLE OF CHRONOLOGICAL SUMMARY OF TIME AND SERVICES PURSUANT TO W.PA.LBR 2016-1(c)(5)(B) IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor : : : : : : : : : : : Bankruptcy No. Chapter Movant v. Related to Document No. Respondent (if none, then "No Respondent") PART A CHRONOLOGICAL SUMMARY OF TIME AND SERVICES RENDERED ON BEHALF OF DEBTOR DURING PERIOD FROM MAY 1, 1985 TO CONCLUSION OF CASE DATE 5/1/85 ATTY RB DESCRIPTION OF SERVICE Conference with Jones Co. representative re: potential purchase of 320 Grant Avenue Telephone call: Virginia Vatz and Pa. Dept. of Revenue Re: tax refund Preparation of Agreement of Sale for 320 Grant Avenue Letter: Pa. Dept. of Revenue re: status of tax claim Review & Sign: Distribution checks Covering letters to all creditors, Anderson, Wagner, Bernstein & Debtor re: the distributions TOTAL HOURS DISBURSEMENTS 6/24/85 8/23/85 JS JS Copy Expense Copy Expense and postage on distribution TOTAL DISBURSEMENTS $ $ $ HOURS 5/2/85 JS 5/3/85 5/4/85 9/17/85 9/18/85 RB JS JS JS PAWB Local Form 9 (07/13) Page 5of 7 American LegalNet, Inc. www.FormsWorkFlow.com BILLING SUMMARY JS RB 2 Hrs. 0 Min. 2 Hrs. 0 Min. CLIENT TOTAL: CURRENT BILLING: CURRENT EXPENSES: TOTAL AMOUNT DUE: $135.00 $125.00 $ $ $ $ $ $ PAWB Local Form 9 (07/13) Page 6of 7 American LegalNet, Inc. www.FormsWorkFlow.com IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor : : :