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B 203 (12/94) United States Bankruptcy Court _______________ District Of _______________ In re Case No. ___________ Debtor Chapter _________ DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR 1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certi fy that I am the attorney for the above- named debtor(s) and that compensation paid to me w ithin 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 w ith the bankruptcy case is as follow s: For legal services, I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ Prior to the fi l ing of this statement I have received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ Balance D ue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________ 2. The source of the compensati on paid to me w as: D ebtor O ther (specify) 3. The source of compensation to be paid to me is: D ebtor O ther (specify) 4. I have not agreed to share the above-disclosed compensation w ith any other person unless they are members and associates of my law firm. I have agreed to share the above-disclosed compensation w ith a other person or persons w ho are not members or associates of my law firm. A copy of the agreement, together w ith 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 i n determining whether to file a petition in bankruptcy; b. Preparation and filing of any petition, schedules, statements of affairs and plan which may be required; c. Representati on of the debtor at the meeting of creditors and confi rmation hearing, and any adjourned hearings thereof; 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 proceedings. ___________________________ ___________________________________________________ Date Signature of Attorney _____________________________________________________________ Name of law firm DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR (Continued) d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters; e. [Other provisions as needed] 6. By agreement w ith the debtor(s), the above-disclosed fee does not include the fol low ing services:
