Statement Of Social Security Number (California Southern District)
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Statement Of Social Security Number (California Southern District) Form. This is a California form and can be use in USBC Southern Federal.
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Tags: Statement Of Social Security Number (California Southern District), B21, California Federal, USBC Southern
B 21 [12/01/07]
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.
STATEMENT OF SOCIAL SECURITY NUMBER(S)
(or other Individual Taxpayer-Identification Number(s) (ITIN(s))
1.
Name of Debtor (Last, First, Middle):
(Check the appropriate box and, if applicable, provide the required information.)
Debtor has a Social Security Number and it is:
(If more than one, state all)
Debtor does not have a Social Security Number but has an Individual Taxpayer-Identification Number (ITIN),
and it is:
(If more than one, state all)
Debtor does not have either a Social Security Number or an Individual Taxpayer-Identification Number (ITIN).
2.
Name of Joint Debtor (Last, First, Middle):
(Check the appropriate box and, if applicable, provide the required information.)
Joint Debtor has a Social Security Number and it is:
(If more than one, state all)
Joint Debtor does not have a Social Security Number but has an Individual Taxpayer-Identification Number
(ITIN), and it is:
(If more than one, state all)
Joint Debtor does not have either a Social Security Number or an Individual Taxpayer-Identification Number
(ITIN).
I declare under penalty of perjury that the foregoing is true and correct.
X
Signature of Debtor
Date
Signature of Joint Debtor
Date
X
*Joint debtors must provide information for both spouses.
Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. ยงยง 152 and 3571.
B 21
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