T.L.B.F. 1017-1 UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF COLORADO In re: ___________________________ ___________________________ (Insert Name(s) of Debtor(s)) Address____________________ ___________________________ Last 4 digits of SSN and/or EIN: ___________________________ Debtor(s). Case No. __________ Chapter ___________ REPORT OF DEBTOR’S FAILURE TO PROVIDE TAX RETURN PURSUANT TO 11 U.S.C. §521(e)(2) AND NOTICE OF PENDING DISMISSAL OF CASE PURSUANT TO T.L.B.R. 1017-1 TO THE DEBTOR AND THE ATTORNEY FOR THE DEBTOR: ____________________ in the above-referenced case, hereby certifies that despite a timely request the Debtor has failed to provide the (name of creditor or trustee)____________________ with a copy of the Federal income tax return or transcript of such return for the most recent tax year ending immediately before the commencement of the case and for which a Federal income tax return was filed, as required by 11 U.S.C. § 521(e)(2), I.B.R. 4002 and T.L.B.R. 1017-1; NOTICE IS HEREBY GIVEN that, pursuant to T.L.B.R. 1017-1 and 11 U.S.C. § 521(e)(2), the case shall be dismissed without further notice, certification, or hearing, unless the Debtor files an objection with the Court by _(specify date: 10 days + 3 for mailing)_. The Debtor’s objection shall include such information as is necessary to demonstrate that the Debtor’s failure to provide the tax return or transcript was due to circumstances beyond the control of the Debtor, as required by 11 U.S.C. §521(e)(2). Dated: Respectfully submitted, _/s/_(in compliance with L.B.R. 910___ Printed Name and Attorney Registration Number Name of Firm Street Address City, State and Zip Code Telephone and Fax Numbers E-mail address 1017-1 Form American LegalNet, Inc. www.FormsWorkflow.com CERTIFICATE OF SERVICE I hereby certify that a copy of this REPORT OF DEBTOR’S FAILURE TO PROVIDE FEDERALTAX RETURN PURSUANT TO 11 U.S.C. §521(e)(2)(A) AND NOTICE OF PENDING DISMISSAL OF CASE PURSUANT TO T.L.B.R. 1017-1 was mailed, postage prepaid, on ____(date)___, to the following: Debtor’s Attorney Debtor Trustee United States Trustee ____________________ Signed 1017-1 Form American LegalNet, Inc. www.FormsWorkflow.com