CSD 1006 [12/01/15] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. APPLICATION TO PAY FILING FEES IN INSTALLMENTS In accordance with FRBP 1006, application is made for permission to pay half the filing fee at the time the petition is filed with the balance of the fee in not more than one installment due within 30 days of petition file date. (check one): Chapter 7 payment of $167.50 Chapter 11 payment of $858.50 Chapter 13 payment of $155.00 Chapter 12 payment of $137.50 I certify that I am unable to pay the filing fee except in installments and I understand the following: I must pay my entire fee before I make any more payments or transfer any more property to an attorney, bankruptcy petition preparer, or anyone else for services in connection with my bankruptcy case. I must pay the entire fee no later than 30 days after I first file for bankruptcy, unless the Court later extends my Deadline. My debts will not be discharged until my entire fee is paid. If I do not make my payment when it is due, my bankruptcy case may be dismissed, and my rights in other bankruptcy proceedings may be affected. Dated: Signed: Signature of Debtor Signed: Dated: Signature of Joint Debtor (if any) Attorney for Debtor(s) If this document is prepared by a Non-Attorney Bankruptcy Petition Preparer, the form 119, Bankruptcy Petition Preparer's Notice, Declaration, and Signature, must be completed and submitted with this Application. Form of payment: Please do not mail cash. Money orders or certified checks only; personal checks of the debtor will not be accepted. CSD 1006 American LegalNet, Inc. www.FormsWorkFlow.com