UNITED STATES BANKRUPTCY COURT Eastern District of California In re Debtor(s). ) ) ) ) ) Case No. APPLICATION TO PAY FILING FEE IN INSTALLMENTS 1. In accordance with Bankruptcy Rule 1006, I (we) apply for permission to pay the filing fee amounting to $ installments. 2. I am (we are) unable to pay the filing fee except in installments. 3. Until the filing fee is paid in full, I (we) will not make any additional payment or transfer any additional property to an attorney or other person for services in connection with this case. 4. I (we) propose the following terms for the payment of the filing fee: $ (check one): $ on or before on or before $ with the filing of the petition OR on or before $ G G in on or before NOTE: The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2). 5. I (we) understand that my (our) discharge, or confirmation of any plan, will be delayed until the filing fee is paid in full. 6. I (we) further understand that if I (we) fail to pay the filing fee in full, then I (we) will not receive a discharge of my (our) debts when my (our) bankruptcy case is closed. Signature of Attorney (if any) Date Signature of Debtor (In a joint case, both spouses must sign.) Date Name of Attorney Bar ID Number Signature of Joint Debtor (if any) Date --------------------------------------------------------------------------------------------------------------------------------------------------------------DECLARATION OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required in that section. __________________________________________________ ___________________________________________ Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. (Required under 11 U.S.C. § 110.) If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person or partner who signs this document. ___________________________________________________ ___________________________________________________ Address X__________________________________________________ Signature of Bankruptcy Petition Preparer ____________________________ Date Names and Social Security Numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition preparer is not an individual: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. EDC 2-020 (Rev. 7/10) American LegalNet, Inc. www.FormsWorkFlow.com