LOCAL OFFICIAL FORM No. 9 LBR 1007-5 COVERSHEET In re ) ) Case No. _____________ ) ) (Chapter ____) ) ) ______________________________, Debtor(s). LBR 1007-5 Declaration of Debtor Regarding Payment Advices Select one of the following: ____ The attached (consisting of ____ pages) represent complete and accurate copies of all payment advices or other evidence of payment I have received from any employer within sixty (60) days before the commencement of this bankruptcy case. privacy protection under Fed. R. Bankr. (Attach all P. 9037.)1 payment advices received, redacting any information entitled to ____ I have received no payment advices or other evidence of payment from any employer within sixty (60) days before the commencement of this bankruptcy case. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Executed on: _______ ________________________________(Signature) ________________________________(Printed Name) ________________________________(Address) ________________________________(Phone No.) Federal Rule of Bankruptcy Procedure 9037(a) provides that the following personal information must be redacted from any payment advices: All but the last four digits of a social-security number or taxpayeridentification number; The month and day of the individual's birth (but not the year); All but the initials of any minor's name; and All but the last four digits of any financial account number. 1 American LegalNet, Inc. www.FormsWorkFlow.com