UNITED STATES BANKRUPTCY COURT DISTRICT OF NEVADA In re: BK: CHAPTER: APPLICATION TO PAY FILING FEE AND ADMINISTRATIVE FEE IN INSTALLMENTS In accordance with Local Rule 1006, an individual may pay in accordance with the Court’s Guidelines for Application to Pay Petition Filing Fee in Installment. Any application requesting payments to be made in a different manner shall be supported by an affidavit describing the special circumstances. 1. 2. 3. 4. In accordance with Federal Rule on Bankruptcy Procedure 1006, I apply for permission to pay the filing fee amounting to $ in installments. I am unable to pay the filing fee except in installments. Until the filing fee is paid in full, I will not make any additional payment or transfer any additional property to an attorney or any other person for services in connection with this case. I propose the following terms for the payment of the filing fee. $ with the filing of the petition, or within fortyeight (48) hours of the filing of the petition. Date: $ to be paid on or before but no more than 30 days after filing of petition. Date: $ to be paid on or before but no more than 60 days after filing of petition. Date: 5. I understand that if I fail to pay any installment when due, my bankruptcy case may be dismissed and I may not receive a discharge of my debts. Date: Signature of debtor Date: Signature of joint debtor Date: Signature of attorney ORDER APPROVING PAYMENT OF FILING FEE IN INSTALLMENTS IT I S ORDERED that the debtor pay the filing fee in installments on the terms set forth in the foregoing application. IT IS FURTHER ORDERED that until the filing fee is paid in full the debtor(s) shall not make any additional payment or transfer any additional property to an attorney for any other person for services in connection with this case. Date: BY THE COURT Mary A. Schott, Clerk of Court Deputy clerk American LegalNet, Inc. www.FormsWorkflow.com