UNITED STATES BANKRUPTCY COURT 

EASTERN DISTRICT OF VIRGINIA 

In re Case Number: 

 Debtor(s) 

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR 

 

1. Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named 

debtor(s) and that compensation paid to me, for services rendered or to be rendered on behalf of the 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 the compensation paid to me was: 

 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 with any other person unless they are members and 

associates of my law firm. 

 I have agreed to share the above-disclosed compensation with a 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 in determining whether to file a 

petition in bankruptcy; 

b. Preparation and filing of any petition, schedules, statement 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; 

d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters; 

e. [Other provisions as needed] 

Not Applicable

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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) in this bankruptcy proceeding. 

_________________________ _____________________________________________ 

Date Signature of Attorney 

_____________________________________________ 

 Name of Law Firm 

For use in Chapter 13 Cases where Fees Requested Not in Excess of $5,223

(For all Cases Filed on or after 01/01/2018) 

NOTICE TO DEBTOR(S), STANDING CHAPTER 13 TRUSTEE AND UNITED 

STATES TRUSTEE

PURSUANT TO LOCAL BANKRUPTCY RULE 2016-1(C) AND

CLERK’S CM/ECF POLICY 9 

Notice is hereby given that pursuant to Local Bankruptcy Rule 2016-1(C), you must file an objection with the court 

to the fees requested in this disclosure of compensation opposing said fees in their entirety, or in a specific amount, no later 

than the last day for filing objections to confirmation of the chapter 13 plan. 

PROOF OF SERVICE 

 The undersigned hereby certifies that on this date the foregoing Notice was served upon the debtor(s), the standing 

Chapter 13 trustee, and U. S. trustee pursuant to Local Bankruptcy Rule 2016-1(C) and the Clerk’s CM/ECF Policy 9, either 

electronically or in paper form (first class mail). 

_______________________________ ___________________________________________ 

Date Signature of Attorney 

[2030edva ver. 01/18] 

/s/ David W. Gaffey

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