Download:
pdf |
pdfPOC
Help
Save
Import
Refresh
OMB NUMBER: 3064-0122
EXPIRATION DATE: 07/31/2013
Federal Deposit Insurance Corporation
EXPERT INVOICE FOR FEES AND EXPENSES (EIF&E)
MATTER NUMBER
MATTER CAPTION
SECTION I – FIRM AND INSTITUTION INFORMATION
INSTITUTION NUMBER
FEDERAL TAX ID NUMBER
FINANCIAL INSTITUTION NAME
CITY
STATE
EXPERT FIRM NAME
ADDRESS
CITY
STATE
ZIP CODE
EXPERT FIRM CONTACT
TELEPHONE NUMBER
EXPERT FIRM ACCOUNTS RECEIVABLE CONTACT
TELEPHONE NUMBER
FDIC OFFICE LOCATION
TELEPHONE NUMBER
FDIC ATTORNEY
SECTION II – CURRENT BILLING INFORMATION
INVOICE NUMBER
BILLING PERIOD DATE (MM/DD/YYYY)
FROM:
FEES BILLED
THROUGH:
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)
File Type | application/pdf |
File Title | FDIC 5210/01, Expert Invoice for Fees and Expenses (EIF&E) |
Subject | invoices, fees |
Author | Carl Polvinale |
File Modified | 2010-08-05 |
File Created | 2007-09-04 |