Disclosure Of Pre-Petition Fees Paid by Debtor To Debtors Counsel {MSNB-LR-1006-1}

MSNB-LR-1006-1 (6/18) Miss. Bankr. L.R. 1006-1(b)(1) requires debtor222s counsel to complete and file this form concurrently with the filing of the application to pay filing fee in installments. Disclosure of Pre-Petition Fees Paid by Debtor to Debtor222s Counsel Pursuant to Miss. Bankr. L. R. 1006-1(b)(1), I certify that I am the attorney for the above-named debtor(s), and that fees paid to me before the filing of the application to pay filing fees in installments in connection with the above-referenced bankruptcy case as follows: Filing fee for voluntary petition, I have received205205205205$ Compensation for legal services, I have received205205205$ Certification I, the attorney for the debtor(s) declare under penalty of perjury that the foregoing is true and correct. Date Signature of Attorney for Debtor(s) MM/DD/YYYY Printed Name Address Line 1 Address Line 2 City, State, and Zip Code Telephone Number MS Bar Number Debtor 1 First Name Middle Name Last Name Debtor 2 (Spouse, if filing) First Name Middle Name Last Name United States Bankruptcy Court for the Northern District of Mississippi Case number (If known) Fill in this information to identify your case: Check if this is anamended disclosure. American LegalNet, Inc. www.FormsWorkFlow.com