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UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) ) Case No. _______________ APPLICATION FOR CHAPTER 12 (Mark One) INITIAL SUPPLEMENTAL/ADDITIONAL COMPENSATION OF ATTORNEY FOR DEBTOR

Debtor(s)

The applicant, _________________________________________________________________, by and through the undersigned, pursuant to 11 USC §331 and LBR 2016-1, applies for compensation as marked above for the period from __________ to __________, and certifies the following is true and correct: 1. The following pre-filing compensation has been received in connection with this case (indicate date, amount, payer, payer's relation to case, and description for all monies and any other consideration received):

2. Applicant requests allowance of compensation for: Legal Services of $________________; Expenses of $________________; for a Total of $________________. 3. Applicant's prior requests for compensation in this case are as follows: Date of Application Amount Requested Fees Expenses Amount Allowed Fees Expenses Amount Received Fees Expenses Payment Source

TOTALS: $__________ $__________ $__________ $__________ $__________ $__________ 1214 (10/15/08) Page 1 of 2

4. Applicant has not shared or agreed to share any compensation received or to be received for services rendered in connection with this case, except with a regular member, partner or associate of Applicant's firm. 5. The rate of compensation, number of hours and requested fee for each person included in this application are summarized as follows: Timekeeper (name & initials) Title Hourly Rate Number Of Hours Requested Fee

6. Attached and incorporated herein by reference are the following schedules (check those that apply): Schedule A - A narrative summary of services provided including total hours and resulting benefits to the estate of each activity category. [Preferred, but only mandatory if application exceeds $3,000.] Schedule B - [If this is the Initial Application for Compensation] A brief narrative and itemization detailing all case related PRE-PETITION fees. [Itemization mandatory; narrative mandatory if compensation requested in the application exceeds $3,000.] Schedule C - An itemized billing setting forth a description of each event, including the date, amount of time spent, and name of the person performing each event. [Mandatory] 7. Applicant's expense reimbursement requests do not exceed the sums specified in LBR 2016-1, except to the extent specifically explained below:

8. On __________ copies of this Application, all attachments thereto, and the required Notice of Application [prepared on Local Form #1214.5] were served on the debtor(s), trustee, and U.S. Trustee; and a separate copy of only the Notice was served on all creditors if required by FRBP 2002(a)(6) (or if original time to file claims has expired, only on creditors who filed claims and entities that filed a request to receive all case notices). DATED: __________ _______________________________________________ Signature _______________________________________________ Signer's Name and Phone # _______________________________________________ Address

1214 (10/15/08) Page 2 of 2