UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW MEXICO In re ___________________________________ Debtor(s). No. APPLICATION TO PAY FILING FEE IN INSTALLMENTS 1. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the filing fee of $ in installments in cash, by money order or by certified check. 2. I am unable to pay the filing fee except in installments. 3. 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. 4. I propose the following terms for the payment of the filing fee* $ $ $ $ Total $ Check one: on or before on or before on or before with filing of petition on or before * The number of installments proposed shall not exceed four (4), and the final payment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2). 5. I understand that if I fail to pay any installment when due, my bankruptcy case may be dismissed, I may not receive a discharge of my debts, and I will still owe the fee to the Bankruptcy Court. Signature of Debtor Date Signature of Joint Debtor Date (In a joint case, both spouses must sign) Address: ___________________________________ City, state, zip: ______________________________ Telephone: ____________________________ E-mail: _______________________________ _____________________________________________ Signature of Attorney Date Attorney name: __________________________ Address: _______________________________ City, state, zip: __________________________ Telephone: _______________________ Facsimile: ________________________ E-mail: __________________________ NM OF 3A F:\FORMS\Fees and money received\installment fee application and order NM OF 3A.wpd American LegalNet, Inc. www.FormsWorkFlow.com