5210/01 Representations and Certifications for Legal Contractors

OMB NUMBER: 3064-0122

EXPIRATION DATE: 03/31/2007

Federal Deposit Insurance Corporation EXPERT INVOICE FOR FEES AND EXPENSES (EIF&E)
MATTER NUMBER			MATTER CAPTION
     			     
SECTION I – FIRM AND INSTITUTION INFORMATION
INSTITUTION NUMBER	FINANCIAL INSTITUTION NAME
     	     
	CITY				STATE
	     				     
FEDERAL TAX ID NUMBER	EXPERT FIRM NAME				ADDRESS
	     				     
	CITY			STATE		ZIP CODE
     	     			     		     
EXPERT FIRM CONTACT					TELEPHONE NUMBER
     					     
EXPERT FIRM ACCOUNTS RECEIVABLE CONTACT					TELEPHONE NUMBER
     					     
FDIC OFFICE LOCATION		FDIC ATTORNEY			TELEPHONE NUMBER
     		     			     
SECTION II – CURRENT BILLING INFORMATION
INVOICE NUMBER			BILLING PERIOD DATE (MM/DD/YYYY)
     			FROM:       THROUGH:      

FEES BILLED	EXPENSES BILLED		GRAND TOTAL
                             	                             		                             
SECTION III – CERTIFICATION
I certify that the information contained herein is true and correct to the best of my knowledge and belief, and that all charges for legal services and disbursements reflected herein are in accordance with our retention agreement with the FDIC Legal Division.
NAME AND TITLE OF EXPERT (Print or type)		AUTHORIZED SIGNATURE		DATE
     				     
PAPERWORK REDUCTION ACT NOTICE: Public reporting burden for this collection of information is estimated to average 1.0 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Public Reporting Act Clearance Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, N.W., Washington, DC 20429, and the Office of Management and Budget, Paperwork Reduction Project (3064-0122), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

FDIC 5210/01 (4-06)