Fill and Sign the Disclosure Debtor Form

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 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, o r agreed to be paid to me, for services rendered or to be rendered on behalf o f t he debtor(s) in contemplation of or in connection with the bankruptcy case is as follows: For legal services, I have agreed to accept ...................................$       Prior to the filing of this statement I have received ............................. $       Balance Due .........................................................$       2. The source of t he compensation paid to me w as: 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 w ith any other person unless they are members and associates of my law firm. I have agreed to share the above-disclosed compensation with a other 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 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. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof; 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 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) i n this bankruptcy proceedings. ________________________ ___________________________________________________ Date Signature of Attorney _____________________________________________________________ Name of law firm