Statement Of Social Security Numbers
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Statement Of Social Security Numbers Form. This is a Michigan form and can be use in USBC Western Federal.
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Tags: Statement Of Social Security Numbers, Michigan Federal, USBC Western
Attorney/Debtor Name, Address, Phone, Fax, E-mail:
For Court use only
NOT TO BE
FILED
UNITED STATES BANKRUPTCY COURT
WESTERN DISTRICT OF MICHIGAN
Case No.
In re:
Chapter
Debtor(s)
STATEMENT OF SOCIAL SECURITY NUMBERS(S)
1.
Name of Debtor (enter Last, First, Middle):_________________________________________
(Check the appropriate box and, if applicable, provide the required information.)
Debtor has a Social Security Number and it is: _____________________________.
(If more than one, state all.)
Debtor does not have a Social Security Number.
2.
Name of Joint Debtor (enter Last, First, Middle): ___________________________________
(Check the appropriate box and, if applicable, provide the required information.)
Debtor has a Social Security Number and it is: _____________________________
(If more than one, state all.)
Debtor does not have a Social Security Number.
I declare under penalty of perjury that the foregoing is true and correct.
X ________________________________________ ________________
Signature of Debtor
Date
X ________________________________________ ________________
Signature of Debtor
Date
*Joint debtors must provide information for both spouses.
Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. ยงยง 152 and 3571.
B21 12/03
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