This form may only be utilized by Trustees, Debtors in Po ssession or other parties as approv ed by the C ourt. UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY In re: : : : : Debtor(s) : ____________________________________: Case no.: Adv. Pro. No.: Chapter: _________________ _________________ _________________ CERTIFICATION AND AGREEMENT TO PAY FILING FEE I, ___________________________________________ state as follows: 1. I am the Trustee, Counsel for the Trustee, Debtor in Possession in the above captioned matter. I filed a(n) ______________________________________________ relative to the above captioned matter. 2. 3. Currently, the estate in this matter has insufficient funds with which to pay the required filing fee. I agree to pay the required filing fee at such time as the estate has sufficient funds.1 The filing fee is being forwarded to the Court. 4. 5. The amount of the fee2 is $ ________________. I certify under penalty of perjury that the foregoing is true and correct. _____________________________ Signature ____________________________________ Date _____________________________ Name ____________________________________ Telep hone N umber/Email Ad dress ______________________________________________________________________________ Add ress revised 9/17/02 If the primary document was filed electronically, you must attach the Notice of Electronic Filing (NEF) relating to the primary document to the check. If the primary document was filed conventionally, you must attach a copy of this Certification to the check. 2 1 The $5.00 N otice o f App eal Fee required under 28 U.S.C. § 1 930 (c) ma y not be deferred. American LegalNet, Inc. www.USCourtForms.com