Free Local Form LF2016F - CERTIFICATION FOR SUPPLEMENTAL APPLICATION - Washington

Local form 2016F (1/2002)

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON Case Name: _________________________________ Case Number: _____________________ CERTIFICATION FOR SUPPLEMENTAL APPLICATION FOR AWARD OF COMPENSATION AND REIMBURSEMENT IN CHAPTER 13 CASE The undersigned applicant applies to the court for a supplemental award or allowance of compensation for services rendered and for a supplemental reimbursement of expenses incurred in the above entitled case pursuant to LBR 2016-1(e)(4) and in support of this application certifies that: 1. 2. The Plan was confirmed on _______________________; Summary of fees not included in this supplemental application: A. B. C. D. 3 Agreed Flat Fee Approved: Received as Retainer from Debtor: Received from Trustee: Balance $______________ $______________ $______________ 0.00 $______________

All of the compensation and reimbursement applied for by this supplemental application is outside that contemplated by the agreed flat fee approved in this case; The requirements of LBR 2016-1 (a), (b) & (c) have or will be complied with. ___________________________________ (signature of applicant) ___________________________________ (printed name) ___________________________________ ____________________________________ (address) ____________________________________ (telephone number)

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DATED:

CERTIFICATION FOR SUPPLEMENTAL APPLICATION FOR COMPENSATION AND REIMBURSEMENT