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Chapter_12_Trustee_Budget_Form_FY2012

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									                                         EXECUTIVE OFFICE FOR UNITED STATES TRUSTEES
                                                     CHAPTER 12 ANNUAL BUDGET
                                          For the Fiscal Year July 1, 2011, through June 30, 2012
                                                                                                                             Revised 4/11
      NAME: _______________________________________
      DATE: _______________________________________
      REQUESTED % FEE:___________________________

                                             I. Summary of Necessary Expenses

                                                                   Actual         Full-Year         FY 10-11    Proposed       FY 11-12
      Operating Expenses                                           FY 10           FY 11             % Chg.      FY 12          % Chg.
 *1   Employee Expenses………………………………………………….                                                   $0          N/A           $0           N/A
 *2   Office Rent & Utilities……………………………………..………….                                            $0          N/A           $0           N/A
 *3   Bookkeeping & Accounting Services………………………………                                           $0          N/A           $0           N/A
 *4   Computer Services…………………………………………..……….                                                 $0          N/A           $0           N/A
  5   Audit Services…………………………………………….…………..                                                              N/A                        N/A
 *6   Consulting Services…………………………………………………..                                                $0          N/A          $0            N/A
  7   Telephone………………………………………………..…………….                                                                 N/A                        N/A
  8   Postage…………………………………..…………………………….                                                                  N/A                        N/A
  9   Office Supplies…………………………………………………………                                                               N/A                        N/A
*10   Bond Premiums/Insurance (other than employee benefits)………                               $0          N/A          $0            N/A
*11   Dues, Publications & On-Line Services…………………………….                                       $0          N/A          $0            N/A
 12   Training (See Instructions).…………………………..………………                                                      N/A                        N/A
 13   Maintenance & Service Agreements………………..………………                                                      N/A                        N/A
 14   Travel………………………………………………………..………….                                                                  N/A                        N/A
*15   Equipment/Furniture Rental…………………………………..……..                                           $0          N/A          $0            N/A
*16   Equipment/Furniture Purchases………………………………..…..                                          $0          N/A          $0            N/A
 17   Leasehold Improvements…………………………………………….                                                            N/A                        N/A
*18   Other Expenses (list):
      Bank Charges                                                                            $0         N/A           $0              N/A
                                                                                              $0         N/A           $0              N/A
                                                                                              $0         N/A           $0              N/A
                                                                                              $0         N/A           $0              N/A

      Total Necessary Expenses                                              $0                $0         N/A           $0              N/A



                                                                                                                                  page 1 of 15
                               II. Detail of Necessary Expenses
                                                     Full-Year        Proposed        FY 11-12
                                                      FY 11            FY 12           % Chg.
1 Employee Expenses
  A. Gross Salaries
      (1) Salaries                                               $0          $0            N/A
      (2) Overtime                                               $0          $0            N/A
      (3) Bonuses                                                $0          $0            N/A


  Total Salary                                                   $0          $0            N/A


  B. Payroll Taxes- Employer                                     $0          $0            N/A


  C. Employee Benefits
      (1) Health Insurance                                       $0          $0            N/A
      (2) Retirement                                             $0          $0            N/A
      (3) Other Benefits                                         $0          $0            N/A


  Total Employee Benefits                                        $0          $0            N/A


  D. Temporary Labor                                                                       N/A


  Total Employee Expenses                                        $0          $0            N/A


2 Office Rent & Utilities
  A. Total Square Footage Leased (office space)                                            N/A
  B.$ Amount Office Space                                                                  N/A
  C.$ Amount Off-Site Storage                                                              N/A
  D.$ Amount Utilities                                                                     N/A


  Total Rent & Utilities                                         $0              $0        N/A




                                                                                                 page 2 of 15
                                            Full-Year        Proposed        FY 11-12
                                             FY 11            FY 12           % Chg.
3 Bookkeeping & Accounting Services
 A. Vendor name and type of service
                                                                                  N/A
 B. Vendor name and type of service
                                                                                  N/A
 C. Vendor name and type of service
                                                                                  N/A


 Total Bookkeeping & Accounting Services                $0              $0        N/A



4 Computer Services
 A. Vendor name and type of service
                                                                                  N/A
 B. Vendor name and type of service
                                                                                  N/A
 C. Vendor name and type of service
                                                                                  N/A
 D. Vendor name and type of service
                                                                                  N/A


 Total Computer Services                                $0              $0        N/A



6 Consulting Services
 A. Consultant name and area of expertise
                                                                                  N/A
 B. Consultant name and area of expertise
                                                                                  N/A
 C. Consultant name and area of expertise
                                                                                  N/A
 D. Consultant name and area of expertise
                                                                                  N/A


 Total Consulting Services                              $0              $0        N/A




                                                                                        page 3 of 15
                                                            Full-Year        Proposed        FY 11-12
                                                             FY 11            FY 12           % Chg.
10 Bond Premiums/Insurance (other than Employee Ben)
   A. Standing Trustee Surety Bond
   Amount________________Insurer Name____________________                                         N/A
   B. Staff Fidelity Coverage
   Amount________________Insurer Name____________________                                         N/A
   C. Errors and Omissions Insurance
   Amount________________Insurer Name____________________                                         N/A
   D. Worker's Compensation Insurance
   Amount________________Insurer Name____________________                                         N/A
   E.
   Amount________________Insurer Name____________________                                         N/A
   F.
   Amount________________Insurer Name____________________                                         N/A


   Total Bond Premiums/Insurance                                        $0              $0        N/A



11 Dues, Publications & On-Line Services
   A. Mandatory Attorney Licensing Fees                                                           N/A
   B. Other Organization Memberships (limited to $1,000)                                          N/A
   C. Publications & On-Line Services                                                             N/A
   D. PACER/ECF Access Charges                                                                    N/A


   Total Dues, Publications & On-Line Services                          $0              $0        N/A



15 Equipment/Furniture Rental
   A. Business Equipment                                                                          N/A
   B. Computer Equipment                                                                          N/A
   C. Furniture                                                                                   N/A
   D. Other (list)                                                                                N/A


   Total Equipment/Furniture Rental                                     $0              $0        N/A



16 Equipment/Furniture Purchases
   A. Business Equipment                                                                          N/A
   B. Computer Equipment                                                                          N/A
   C. Furniture                                                                                   N/A
   D. Other (list)                                                                                N/A


   Total Equipment/Furniture Purchases                                  $0              $0        N/A




                                                                                                        page 4 of 15
                         Full-Year        Proposed        FY 11-12
                          FY 11            FY 12           % Chg.


18 Other Expenses
  A. Bank charges                                              N/A
  B. (item)                                                    N/A
  C. (item)                                                    N/A
  D. (item)                                                    N/A


  Total Other Expenses               $0              $0        N/A




                                                                     page 5 of 15
               III. Detail of Employee Expenses
                                                           FY 10
                                                           Actual

FISCAL YEAR 2010 SUMMARY

       A.   Salaries (including amounts withheld)
       B.   Overtime
       C.   Bonuses
       D.   Payroll Taxes - Employer
       E.   Total Benefits
       F.   Temporary Labor

TOTAL EMPLOYEE EXPENSES                                             $0




                                                                         TOTAL SALARY
2010 EMPLOYEES                                      NAME                 CHARGED TO CH12




                                                                                           page 6 of 15
                                          III. Detail of Employee Expenses
                                                                       Full-Year    Proposed     FY 11-12
                                                                        FY 11        FY 12        % Chg.

#1   Employee Name & Position:
     Wage Class:
     Month and year of hire:

     Salary                                                                                     N/A
     Overtime, if applicable                                                                    N/A
     Bonus                                                                                      N/A
     Payroll Taxes - Employer (payroll, social security)                                        N/A
     Employee Benefits (list)
       Health Insurance                                                                         N/A
       Retirement                                                                               N/A
       Other Benefits (e.g., life insurance, parking) (identify):                               N/A




       TOTAL Employee Benefits                                                 $0          $0   N/A

TOTAL Employee Expense                                                         $0          $0   N/A


     Average number of hours/week (not to exceed 40hrs/wk)                                      N/A
     Hourly Salary - End of Year                                                                N/A




                                                                                                            page 7 of 15
                                          III. Detail of Employee Expenses
                                                                       Full-Year    Proposed     FY 11-12
                                                                        FY 11        FY 12        % Chg.

#2   Employee Name & Position:
     Wage Class:
     Month and year of hire:

     Salary                                                                                     N/A
     Overtime, if applicable                                                                    N/A
     Bonus                                                                                      N/A
     Payroll Taxes - Employer (payroll, social security)                                        N/A
     Employee Benefits (list)
       Health Insurance                                                                         N/A
       Retirement                                                                               N/A
       Other Benefits (e.g., life insurance, parking) (identify):                               N/A




       TOTAL Employee Benefits                                                 $0          $0   N/A

TOTAL Employee Expense                                                         $0          $0   N/A


     Average number of hours/week (not to exceed 40hrs/wk)                                      N/A
     Hourly Salary - End of Year                                                                N/A




                                                                                                            page 8 of 15
                                          III. Detail of Employee Expenses
                                                                       Full-Year    Proposed     FY 11-12
                                                                        FY 11        FY 12        % Chg.

#3   Employee Name & Position:
     Wage Class:
     Month and year of hire:

     Salary                                                                                     N/A
     Overtime, if applicable                                                                    N/A
     Bonus                                                                                      N/A
     Payroll Taxes - Employer (payroll, social security)                                        N/A
     Employee Benefits (list)
       Health Insurance                                                                         N/A
       Retirement                                                                               N/A
       Other Benefits (e.g., life insurance, parking) (identify):                               N/A




       TOTAL Employee Benefits                                                 $0          $0   N/A

TOTAL Employee Expense                                                         $0          $0   N/A


     Average number of hours/week (not to exceed 40hrs/wk)                                      N/A
     Hourly Salary - End of Year                                                                N/A




                                                                                                            page 9 of 15
                                          III. Detail of Employee Expenses
                                                                       Full-Year    Proposed     FY 11-12
                                                                        FY 11        FY 12        % Chg.

#4   Employee Name & Position:
     Wage Class:
     Month and year of hire:

     Salary                                                                                     N/A
     Overtime, if applicable                                                                    N/A
     Bonus                                                                                      N/A
     Payroll Taxes - Employer (payroll, social security)                                        N/A
     Employee Benefits (list)
       Health Insurance                                                                         N/A
       Retirement                                                                               N/A
       Other Benefits (e.g., life insurance, parking) (identify):                               N/A




       TOTAL Employee Benefits                                                 $0          $0   N/A

TOTAL Employee Expense                                                         $0          $0   N/A


     Average number of hours/week (not to exceed 40hrs/wk)                                      N/A
     Hourly Salary - End of Year                                                                N/A




                                                                                                            page 10 of 15
                                          III. Detail of Employee Expenses
                                                                       Full-Year    Proposed     FY 11-12
                                                                        FY 11        FY 12        % Chg.

#5   Employee Name & Position:
     Wage Class:
     Month and year of hire:

     Salary                                                                                     N/A
     Overtime, if applicable                                                                    N/A
     Bonus                                                                                      N/A
     Payroll Taxes - Employer (payroll, social security)                                        N/A
     Employee Benefits (list)
       Health Insurance                                                                         N/A
       Retirement                                                                               N/A
       Other Benefits (e.g., life insurance, parking) (identify):                               N/A




       TOTAL Employee Benefits                                                 $0          $0   N/A

TOTAL Employee Expense                                                         $0          $0   N/A


     Average number of hours/week (not to exceed 40hrs/wk)                                      N/A
     Hourly Salary - End of Year                                                                N/A




                                                                                                            page 11 of 15
                                          IV. Yearly Allocated Expense
                                                                                            Full-Year   Proposed   FY 11-12
                                                                                             FY 11       FY 12      % Chg.
Expense Item
Total Cost
Cost allocated to Chapter 12 Operation
Allocation Percentage (Identify Other Party)                                                                       #VALUE!

Justification for Allocation


Expense Item
Total Cost
Cost allocated to Chapter 12 Operation
Allocation Percentage (Identify Other Party)                                                                       #VALUE!

Justification for Allocation


Expense Item
Total Cost
Cost allocated to Chapter 12 Operation
Allocation Percentage (Identify Other Party)                                                                       #VALUE!

Justification for Allocation


Expense Item
Total Cost
Cost allocated to Chapter 12 Operation
Allocation Percentage (Identify Other Party)                                                                       #VALUE!

Justification for Allocation




#-Examples of "Justification for Allocation" are hours worked, square footage, number of employees




                                                                                                                              page 12 of 15
                                                       V. Workload Section

                                                                   Actual             Full-Year           Proposed             FY 11-12
                                                                   FY 10               FY 11               FY 12                % Chg.

1. a) Actual receipts, net of refunds
       (exclude constructive receipts)                                                                                       N/A
   b) Constructive receipts                                                                                                  N/A
   c) Actual disbursements subject to percentage fee,
      which do not exceed $450,000 in any one plan                                                                           N/A
   d) Actual disbursements subject to percentage fee,
      which exceed $450,000 in any one plan (1)                                                                              N/A
   e) Interest earned on trust and expense funds,
       actual or estimate                                                                                                    N/A
   f) Revenue from awards under Section 503(b)                                                                               N/A

2.   a)     Average Percentage fee, actual or requested
     b)     Revenue from fixed fees (Item 1(c) x Item 2(a))                  0                    0                      0   N/A
     c)     Revenue from 3% disbursements (Item 1(d) x 3%)                   0                    0                      0   N/A
     d)    Revenue from fees on direct payments
           (Item 1(b) x Item 2(a))                                           0                    0                      0   N/A

3. Cases active, start of period                                                                  0                      0   N/A

4. New Cases filed during fiscal year (+)                                                                                    N/A

5. Adjustments during fiscal year:
   a) Cases transferred in (+)                                                                                               N/A
   b) Cases converted from another chapter (+)                                                                               N/A
   c) Cases transferred out (-)                                                                                              N/A
   d) Conversions to another chapter (-)                                                                                     N/A
   e) Dismissals (-)                                                                                                         N/A
   Total Adjustment (+) or (-)                                               0                    0                      0   N/A

6. Cases closed on completion of plan (-)                                                                                    N/A

7. Cases closed on hardship discharge (-)                                                                                    N/A

8. Cases active, end of period (3+4+/-5-6-7)                                 0                    0                      0   N/A

     (1)Disbursements in cases where the aggregate amount of payments made under the plan exceeds $450,000
     are subject to a maximum 3.0% fee (see 28 USC Section 586 (e)(1)(B)(ii)(II)) and should be broken out separately.



                                                                                                                                          page 13 of 15
                                   VI. Bond Calculation
                        (1) FY11          (2) FY11           (3) FY12           4) FY12
                        MONTHLY           HIGHEST            MONTHLY            ESTIMATE
                        RECEIPTS          DAILY TOTAL        RECEIPTS           HIGHEST
                        FULL YEAR         BANK               FULL YEAR          DAILY TOTAL
                        ESTIMATE          BALANCE            ESTIMATE           BANK BALANCE

JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE

TOTAL
Same as item V(1)(a)                 0                                    0

Upcoming Year Estimate:
Highest Daily Total Bank Balance                         x   110%     =                       $0
                                                                              Bond Required

NOTE: Upcoming Year Bond Calculation is Based on the Highest Daily Total Bank Balance Listed in Column (4) x 110%




                                                                                                                    page 14 of 15
  VII. Computation of Amount Available for Compensation and Operating Reserve

 1. End-of-Year FY 11 Operating Reserve
   (should equal estimated expense account balance at end of FY 11)

 2. Interest earned on trust and expense funds [same as V.1(e)]                                0

 3. Revenue from awards under Section 503(b) [same as V.1(f)]                                  0

 4. Revenue from percentage fees [same as V.2(b) +V.2(c)]                                      0

 5. Revenue from fees on direct payments [same as V.2(d)]                                      0

 6. Total revenue [1+2+3+4+5]                                                                  0

 7. Less Total Operating Expenses [same as total of I. Summary of Necessary Expenses]          0

 8. Balance of funds available for compensation (inclusive of 33.5% benefits)
    and operating reserve [6-7]                                                                0

   NOTE: Entries for lines 2-8 reflect numbers for upcoming year


STANDING TRUSTEE'S CERTIFICATION TO BUDGET REQUEST

I hereby certify that the information contained herein is correct, and request that this
annual budget be examined and reviewed by the United States Trustee. I also certify
that all dealings with related parties, as defined in 28 CFR Part 58.4, have been disclosed.




                                               Chapter 12 Standing Trustee's Signature



REVIEWED BY:                                   REVIEWED BY:




Standing Trustee Coordinator                   United States Trustee



                                                                                                   page 15 of 15

								
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