ATTY Name Atty Address Atty Address Atty Phone No.: Atty Fax No.: UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF CALIFORNIA In re: «both» Chapter 13 Case No: «print_casenum» DECLARATION OF EMPLOYMENT INCOME Debtor(s) I, _____________________________ hereby declare the following: My total monthly employment income for each of the six months prior to the month of the filing of this case was as follows: Total Employment Income for ______________ was: Total Employment Income for ______________ was: Total Employment Income for ______________ was: Total Employment Income for ______________ was: Total Employment Income for ______________ was: Total Employment Income for ______________ was: $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ Attached are copies of my payment advices from the 60 day period prior to my bankruptcy filing. I declare this statement is true and correct under penalty of perjury. Executed this ______day of ____________, 20_____, in __________________, California. Debtor 8/1/13 American LegalNet, Inc. www.FormsWorkFlow.com