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Disclaimer Statement Form. This is a Washington form and can be use in USBC Western Federal.
Tags: Disclaimer Statement, Washington Federal, USBC Western
UNITED STATES BANKRUPTCY COURT
WESTERN DISTRICT OF WASHINGTON
In re:
Case No.
Name of Debtor(s)
1.
(If Known)
Pursuant to 11 U.S.C. ' 329(a) and Bankruptcy Rule 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 follow:
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:
q
3.
Debtor
q Other (specify)
The source of compensation to be paid to me is:
q
5.
q
I have not agreed to share the above-disclosed compensation with any other person unless they are
members and associates of my law firm.
q
4.
Debtor
q Other (specify)
I have agreed to share the above-disclosed compensation with a 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.
In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case,
including:
a.
b.
Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;
c.
Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned
hearings thereof;
d.
Representation of the debtor in adversary proceedings and other contested bankruptcy matters;
e.
6.
Analysis of the debtor=s financial situation, and rendering advice to the debtor in determining whether to file a
petition in bankruptcy;
[Other provisions as needed].
By agreement with the debtor(s), the above-disclosed fee does not include the following services
CERTIFICATION
I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for
representation of the debtor(s) in this bankruptcy proceeding.
__________________________________
Date
__________________________________________
Signature of Attorney
__________________________________________
Name of Law Firm
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