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Application To Pay Filing Fee In Installments In Individual Chapter 11 Or 13 Cases Form. This is a Georgia form and can be use in Bankruptcy Court Federal.
Tags: Application To Pay Filing Fee In Installments In Individual Chapter 11 Or 13 Cases, Georgia Federal, Bankruptcy Court
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF GEORGIA
____________ DIVISION
In re
Case No. _________
________________________,
Debtor.
Chapter _________
APPLICATION TO PAY FILING FEE IN INSTALLMENTS
FOR INDIVIDUALS IN CHAPTER 11 OR 13 CASES
1. In accordance with Fed. R. Bankr. P. 1006 and General Order No. 4-2005 (Bankr. N.D. Ga.,
October 5, 2005), I apply to pay the filing fee amounting to $_______ in no more than three (3)
installments.
2. I certify that I am unable to pay the filing fee except in installments.
3. I further certify that I will neither make any payment nor transfer any property for services in
connection with this case until the filing fee is paid in full.
4. I accept the following terms for the payment of the filing fee:
! First Installment of $_______, with the filing of the petition.
! Second Installment of at least one-half of the unpaid balance of the filing fee in the
amount of $_______, on or before 30 days from the date the bankruptcy petition
was filed.
! Final Installment of the remaining unpaid balance of the filing fee in the amount of
$_______, on or before 60 days from the date the bankruptcy petition was filed.
5. I understand that if I fail to pay any fee installment when due my bankruptcy case will be
dismissed.
_____________________________
Signature of Attorney
Date
_________________________________
Signature of Debtor
Date
(In a joint case, both Debtors must sign)
_____________________________
Name of Attorney
_________________________________
Signature of Joint Debtor
Date
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DECLA RATION AND SIGN ATUR E OF NO N-ATTO RNEY BANK RUPTC Y PETITION (See 11 U.S.C. § 110)
I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared
this document for compensation and have provided the debtor with a copy of this document and the notices and information
required under 11 U .S.C. §§ 110(b), 110 (h), and 342(b); (3) if rules or guidelines have been promulgated pursuant to 11
U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor
notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor,
as required under that section; and (4) I will not accept any additional money or other property from the debtor before the
filing fee is paid in full.
_____________________________________________________
____________________________________
Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer
Social Security No. (Required by 11 U.S.C. § 110.)
If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer,
principal, responsible person, or partner who signs the document.
________________________________
________________________________
Add ress
x____________________________________________________
Signature of Bankruptcy Petition Preparer
_____________________________________
Date
Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the
bankruptcy petition preparer is not an individual:
If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official
Form for each person.
A bankruptcy p etition prepa rer’s failure to com ply with the p rovisions of title 11 and the Federal Rules of Bankruptcy
Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
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