REQUEST BY TRUSTEE FOR COPY WORK AND/OR CERTIFICATION

WITHOUT PREPAYMENT OF FEES

RE: , Debtor

CASE NO.:

I hereby represent that I am the trustee, or agent for the trustee, in the above-referenced case, and am in need of copies or certifications of papers for which reimbursement will be made from the estate, if any, at the conclusion of this case. The papers are as follows:

DOCUMENT NO./CERTIFICATION

DATE FILEDDOCUMENT NAME (If checked)

DATED:

[ ] Trustee[ ] Attorney for Trustee

FOR COURT'S USE:

No. of Pages: x $ .50	=	$

No. of Certifications: x $11.00	=

TOTAL DUE ESTATE :	$

COMPLETED ON BY:	, Deputy Clerk