United States Bankruptcy CourtDistrict of KansasIn re , Case No.Debtor Chapter DECLARATION REGARDING PAYMENT ADVICES OR EVIDENCE OF PAYMENTUNDER 11 U.S.C. 247 521(a)(1)(B)(iv) I declare (or certify, verify, or state) under penalty of perjury that the following is true andcorrect (CHECK ONE OF THESE BOXES):G I have not been employed by any employer within the 60 days before the date of the filing of thepetition. G I was employed by an employer within 60 days before the date I filed my bankruptcy petition,but I have not received payment advices or other evidence of payment because. G I have received payment advices or other evidence of payment within 60 days before the date Ifiled my bankruptcy petition from any employer, and they are attached.Executed on (date) by (debtor) American LegalNet, Inc. www.FormsWorkFlow.com