DISCLOSURE OF ATTORNEY COMPENSATION
FOR DEBTOR
United States Bankruptcy Court
District of _______________________________
In re: ___________________________________
Bankruptcy Case No. ______________________
Debtor __________________________________
1. Pursuant to 11 U.S.C. Sec. 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 follows;
For legal services, I have agreed to accept
________________ dollars ($__________).
Prior to the filing of this statement I have
received ______________________ dollars ($__________). The Balance Due is
_____________________dollars ($__________).
2. The source of the compensation paid to me was: [
] Debtor [ ] Other (specify)
3. The source of
compensation to be paid to me is: [ ] Debtor [ ] Other (specify)
4. [ ] I
have not agreed to share the above-disclosed compensation with any other
person unless they are members and associated of my law firm.
[ ] 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.
5. In return for the above-disclosed fee, I have
agreed to render legal service for all aspects of the bankruptcy case,
including:
a. Analysis
of the debtor’s financial situation, and rendering advice to the debtor in
determining whether to file a petition in bankruptcy;
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 adjourned hearings thereof;
d.
Representation of the debtor in adversary proceedings and other
contested bankruptcy matter;
e. [Other
provisions as needed].
6. 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