UNITED STATES BANKRUPTCY COURT District of New Jersey APPLICATION FOR SEARCH OF BANKRUPTCY RECORDS Name of individual or business that is the subject of the search: (Please submit a separate application for each name/case Social Security No. or Employer I.D. No. of Subject: number searched) 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 in this district;  Judgments/evidence of satisfaction of judgments, and  Other [describe briefly] Please search for the period of ______________________________ to ______________________________. A fee of $30.00 is charged for each name/item searched. Payment must be made by attorney/business check, certified check or money order. Name, address and telephone 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 this Court: [Check only the items for which a search was requested and a fee paid.] A. Bankruptcy cases:   Pending or  Case no.: ______________________  Involuntary  B. None found Discharge granted on: ___________________________________________________________  Closed on: _____________________________________________________  Case filed on: ______________________________ Involuntary Adversary Proceedings:  None found  Pending or  Closed on: _____________________________________________________ Subject is/was a party to the following proceedings: ___________________________________V. _____________________________________________ Adversary no.: ______________________________Filed on: ________________________________ Case no. of related bankruptcy: _________________________________________________________ Dismissed on ____________________________ Date: _________________ Final judgment entered on: _________________ By: ____________________________________ Deputy Clerk Rev.7/18/12 American LegalNet, Inc. www.FormsWorkFlow.com