Statement Under Penalty Of Perjury Concerning Payment Advices
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Statement Under Penalty Of Perjury Concerning Payment Advices Form. This is a Colorado form and can be use in Bankruptcy Court Federal.
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Tags: Statement Under Penalty Of Perjury Concerning Payment Advices, LBF 1007-6.1, Colorado Federal, Bankruptcy Court
Local Bankruptcy Form 1007-6.1
United States Bankruptcy Court
_______________ District Of _______________
In re __________________________________________,
[Set forth here all names including married,
maiden, and trade names used by debtor within
last 8 years.]
Debtor
)
)
)
)
) Case No. ________________
)
Address ________________________________________ )
)
________________________________________ ) Chapter ___________
)
Last four digits of Social-Security or Individual TaxPayer-Identification (ITIN) No(s).,(if any): ___________ )
______________________________________________ )
Employer Tax-Identification (EIN) No(s).(if any): _____ )
_______________________________________________ )
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STATEMENT UNDER PENALTY OF PERJURY
CONCERNING PAYMENT ADVICES
I*,
, state as follows:
I did not file with the court copies of some or all payment advices or other
evidence of payment received within 60 days before the date of the filing of the petition
from any employer because:
Check applicable boxes:
[ ] I was not employed during the period immediately preceding the filing of the
above-referenced case,
[ ] I was employed during the period immediately preceding the filing of the above
referenced case but did not receive any payment advices or other evidence of payment
from my employer within 60 days before the date of the filing of the petition;
[ ] I am self-employed and do not receive any evidence of payment from an employer;
[ ] Other (please provide explanation): ______________________________________.
I declare under penalty of perjury that the foregoing statement is true and correct.
Dated: ______________________
By: __________________________________
Signature of debtor
_____________________________________
Printed name of debtor
Home address
Telephone number
Facsimile number
E-mail address
* A separate form must be signed for each debtor.
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