Free ATTORNEY FEE APPLICATION COVER SHEET - New Jersey

D.N.J. LOCAL FORM 3 UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY ATTORNEY FEE APPLICATION COVER SHEET

IN RE: CASE NO: CHAPTER:

APPLICANT: CLIENT: CASE FILED: COMPLETION OF THIS FORM CONSTITUTES A CERTIFICATION UNDER PENALTY OF PERJURY. RETENTION ORDERS ATTACHED.

___________________________________ SIGNATURE OF APPLICANT DATE SECTION 1 FEE SUMMARY INTERIM FEE APPLICATION NO. TOTAL PREVIOUS FEE REQUESTED: TOTAL FEES ALLOWED TO DATE: TOTAL RETAINER (IF APPLICABLE) TOTAL HOLDBACK (IF APPLICABLE) TOTAL RECEIVED BY APPLICANT NAME OF PROFESSIONAL & TITLE 1. 2. 3. 4. 5. 6. 7. FEE TOTALS - PAGE 2 DISBURSEMENTS TOTALS - PAGE 3 TOTAL FEE APPLICATION YEAR ADMITTED

$ $ $ $ $ HOURS RATE FEE

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D.N.J. Local Form 3

[Page 2] SECTION II SUMMARY OF SERVICES HOURS SERVICES RENDERED a) Telephone Calls b) Correspondence Drafted c) Correspondence Reviewed d) Legal Research e) Court Appearance f) Preparation of Pleadings and Briefs g) Internal Office Meetings: (1) solely w/applicants staff: (2) third party conferences: FEE

h) Out of Office Meetings i) Review of File j) Travel Time k) Fee Application Preparation l) Other Services: ____________________________________________________ (Continue other services to separate page if needed.) __________ __________ __________ __________

SERVICES TOTAL:

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D.N.J. Local Form 3

[Page 3] SECTION III SUMMARY OF DISBURSEMENTS DISBURSEMENTS a) Telephone b) Messenger Service c) Photocopying No. of Pages Rate per Page (Max. .20¢/pg.) AMOUNT

d) Travel (attach details-U.S. Gov't rate) e) Postage f) Other (explain) _____________________________________________________ _____________________________________________________ _____________________________________________________ _______________________ _______________________ _______________________

DISBURSEMENTS TOTAL:

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D.N.J. Local Form 3

[Page 4] SECTION IV CASE HISTORY (NOTE: Items 3 - 6 are not applicable to applications under 11 U.S.C. § 506)

(1)

DATE CASE FILED:

(2) (3)

CHAPTER UNDER WHICH CASE WAS COMMENCED: DATE OF RETENTION: (ANNEX COPY OF ORDER(S)) IF LIMIT ON NUMBERS OF HOURS OR OTHER LIMITATIONS TO RETENTION, SET FORTH: SUMMARIZE IN BRIEF THE BENEFITS TO THE ESTATE AND ATTACH SUPPLEMENTS AS NEEDED:

(4)

(5)

ANTICIPATED DISTRIBUTION TO CREDITORS: (A) ADMINISTRATION EXPENSES: (B) SECURED CREDITORS: (C) PRIORITY CREDITORS: (D) GENERAL UNSECURED CREDITORS:

(6)

FINAL DISPOSITION OF CASE AND PERCENTAGE OF DIVIDEND PAID TO CREDITOR (IF APPLICABLE):

[Effective April 15, 1993]

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