UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov APPLICATION FOR SEARCH OF BANKRUPTCY RECORDS Name of individual or business that is subject of the search: Social Security No. or Individual TaxpayerIdentification No. (ITIN) of Subject: Employer Tax I.D. No. (EIN) of Subject: (if any): Please search your records for the following information regarding the individual or business named above: pending or closed bankruptcy cases in this district; pending or closed adversary proceedings; judgments/evidence of satisfaction of judgments; and other [describe briefly] A fee of $31.00 is charged for each name or item searched plus $11.00 per certification. Payment by money order or check must be made payable to "Clerk, U.S. Court" and must accompany the request. DO NOT SEND CASH THROUGH THE MAIL. Name, address, and phone number of the person requesting the search: CERTIFICATE OF SEARCH The undersigned clerk hereby certifies the following results of a diligent search of the records of the court: [Check only the items for which a search was requested and a fee paid.] TYPE OF CASE: Bankruptcy Adversary Other CASE FILED ON: CASE NAME: The following information pertains to the main bankruptcy case only: TYPE: CLAIMS DEADLINE: STATUS: Voluntary Date: Pending Closed on Involuntary Chapter CASE NO: None Found Discharge granted on (date) The following information pertains to the adversary case only: STATUS: DISPOSITION: [Seal of Court] Pending Closed on (date) (date) Dismissed on Final Judgment entered on (date) Case Number(s) of Related Bankruptcy Case(s) CLERK OF COURT By: Record Searched on: Date Telephone: Deputy Clerk * This form may contain complete social-security numbers. It should not be filed electronically. LF-85 (rev. 12/01/16) American LegalNet, Inc. www.FormsWorkFlow.com