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Application For And Order On Waiver Of Chapter 7 Filing Fee For Individuals Who Cannot Pay (NYEB) Form. This is a New York form and can be use in Bankruptcy Court Federal.
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Tags: Application For And Order On Waiver Of Chapter 7 Filing Fee For Individuals Who Cannot Pay (NYEB), B3B, New York Federal, Bankruptcy Court
B3B (Official Form 3B) (11/11)
APPLICATION FOR WAIVER OF THE CHAPTER 7 FILING FEE
FOR INDIVIDUALS WHO CANNOT PAY THE FILING FEE
IN FULL OR IN INSTALLMENTS
The court fee for filing a case under chapter 7 of the Bankruptcy Code is $306.
If you cannot afford to pay the full fee at the time of filing, you may apply to pay the fee
in installments. A form, which is available from the bankruptcy clerk’s office, must be
completed to make that application. If your application to pay in installments is
approved, you will be permitted to file your petition, generally completing payment of
the fee over the course of four to six months.
If you cannot afford to pay the fee either in full at the time of filing or in installments,
you may request a waiver of the filing fee by completing this application and filing it
with the Clerk of Court. A judge will decide whether you have to pay the fee. By law,
the judge may waive the fee only if your income is less than 150 percent of the official
poverty line applicable to your family size and you are unable to pay the fee in
installments. You may obtain information about the poverty guidelines at
www.uscourts.gov or in the bankruptcy clerk’s office.
Required information. Complete all items in the application, and attach requested
schedules. Then sign the application on the last page. If you and your spouse are filing a
joint bankruptcy petition, you both must provide information as requested and sign the
application.
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B3B (Official Form 3B) (11/11) -- Cont.
UNITED STATES BANKRUPTCY COURT
__________ District of __________
Eastern District of New York
In re: ___________________
Case No. ___________________
Debtor(s)
(if known)
APPLICATION FOR WAIVER OF THE CHAPTER 7 FILING FEE
FOR INDIVIDUALS WHO CANNOT PAY THE FILING FEE IN FULL OR IN INSTALLMENTS
Part A. Family Size and Income
1.
Including yourself, your spouse, and dependents you have listed or will list on Schedule I (Current
Income of Individual Debtors(s)), how many people are in your family? (Do not include your spouse if
you are separated AND are not filing a joint petition.) __________
2.
Restate the following information that you provided, or will provide, on Line 16 of Schedule I. Attach
a completed copy of Schedule I, if it is available.
Total Combined Monthly Income (Line 16 of Schedule I):
3.
$_________
State the monthly net income, if any, of dependents included in Question 1 above. Do not include any
income already reported in Item 2. If none, enter $0.
$_________
4.
Add the “Total Combined Monthly Income” reported in Question 2 to your dependents’ monthly net
income from Question 3.
$_________
5.
Do you expect the amount in Question 4 to increase or decrease by more than 10% during the next 6
months? Yes ___ No ___
If yes, explain.
Part B. Monthly Expenses
6.
EITHER (a) attach a completed copy of Schedule J (Schedule of Monthly Expenses), and state your
total monthly expenses reported on Line 18 of that Schedule, OR (b) if you have not yet completed
Schedule J, provide an estimate of your total monthly expenses.
$ __________
7.
Do you expect the amount in Question 6 to increase or decrease by more than 10% during the next 6
months? Yes ___ No ___
If yes, explain.
Part C. Real and Personal Property
EITHER (1) attach completed copies of Schedule A (Real Property) and Schedule B (Personal Property),
OR (2) if you have not yet completed those schedules, answer the following questions.
8.
State the amount of cash you have on hand.
$ __________
9.
State below any money you have in savings, checking, or other accounts in a bank or other financial
institution.
Bank or Other Financial Institution:
Type of Account such as savings,
checking, CD:
Amount:
_________________________
___________________
$ __________
_________________________
___________________
$ __________
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B3B (Official Form 3B) (11/11) -- Cont.
10. State below the assets owned by you. Do not list ordinary household furnishings and clothing.
Address:
Home
Value: $ __________
____________________________
Amount owed on mortgages and liens: $ __________
____________________________
Address:
Other real estate
Value: $ __________
____________________________
Amount owed on mortgages and liens: $ __________
_____________________________
Motor vehicle
Amount owed: $ __________
Model/Year: ___________________
Value: $ __________
____________________________
Amount owed: $ __________
Description___________________
Value: $ __________
___________________________
Other
Value: $ __________
____________________________
Motor vehicle
Model/Year: ___________________
Amount owed: $ __________
11. State below any person, business, organization, or governmental unit that owes you money and the
amount that is owed.
Name of Person, Business, or Organization that Owes You
Money
Amount Owed
__________________________________
$ __________
__________________________________
$ __________
Part D. Additional Information.
12. Have you paid an attorney any money for services in connection with this case, including the
completion of this form, the bankruptcy petition, or schedules? Yes ___ No ___
If yes, how much have you paid? $ __________
13. Have you promised to pay or do you anticipate paying an attorney in connection with your
bankruptcy case? Yes ___ No ___
If yes, how much have you promised to pay or do you anticipate paying? $ __________
14. Have you paid anyone other than an attorney (such as a bankruptcy petition preparer, paralegal,
typing service, or another person) any money for services in connection with this case, including the
completion of this form, the bankruptcy petition, or schedules? Yes ___ No ___
If yes, how much have you paid? $ __________
15. Have you promised to pay or do you anticipate paying anyone other than an attorney (such as a
bankruptcy petition preparer, paralegal, typing service, or another person) any money for services in
connection with this case, including the completion of this form, the bankruptcy petition, or schedules?
Yes ___ No ___
If yes, how much have you promised to pay or do you anticipate paying? $ __________
16. Has anyone paid an attorney or other person or service in connection with this case, on your behalf?
Yes ___ No ___
If yes, explain.
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B3B (Official Form 3B) (11/11) -- Cont.
17. Have you previously filed for bankruptcy relief during the past eight years? Yes ___ No ___
Case Number (if
known)
___________________
Year filed
Location of filing
Did you obtain a discharge? (if known)
_______
______________
Yes ____
No ____ Don't know ____
___________________
_______
______________
Yes ____
No ____ Don't know ____
18. Please provide any other information that helps to explain why you are unable to pay the filing fee in
installments.
19. I (we) declare under penalty of perjury that I (we) cannot currently afford to pay the filing fee in full or
in installments and that the foregoing information is true and correct.
Executed on: ___________________
Date
___________________
Date
________________________________
Signature of Debtor
________________________________
Signature of Codebtor
-----------------------------------------------------------------------------------------------------------------------------------------------------DECLARATION AND SIGNATURE OF BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)
I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared
this document for compensation and have provided the debtor with a copy of this document and the notices and information
required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); and (3) if rules or guidelines have been promulgated pursuant to 11
U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor
notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as
required under that section.
___________________________________________________________ __________________________
Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer
Social-Security No. (Required by
11 U.S.C. §110.)
If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social-security number of
the officer, principal, responsible person, or partner who signs the document.
________________________________
________________________________
Address
x__________________________________________________
Signature of Bankruptcy Petition Preparer
_____________________
Date
Names and Social-Security numbers of all other individuals who prepared or assisted in preparing this document, unless the
bankruptcy petition preparer is not an individual:
If more than one person prepared this document, attach additional signed sheets conforming to the appropriate
Official Form for each person.
A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy
Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
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B3B (Official Form 3B) (11/11) -- Cont.
UNITED STATES BANKRUPTCY COURT
__________ District of __________
Eastern District of New York
In re: ___________________
Debtor(s)
Case No. ___________________
ORDER ON DEBTOR’S APPLICATION FOR WAIVER OF THE CHAPTER 7 FILING FEE
Upon consideration of the debtor’s “Application for Waiver of the Chapter 7 Filing Fee,” the court orders
that the application be:
[ ] GRANTED.
This order is subject to being vacated at a later time if developments in the administration of the
bankruptcy case demonstrate that the waiver was unwarranted.
[
] DENIED.
The debtor shall pay the chapter 7 filing fee according to the following terms:
$ __________ on or before __________
$ __________ on or before __________
$ __________ on or before __________
$ __________ on or before __________
Until the filing fee is paid in full, the debtor shall not make any additional payment or transfer any
additional property to an attorney or any other person for services in connection with this case.
IF THE DEBTOR FAILS TO TIMELY PAY THE FILING FEE IN FULL OR TO TIMELY MAKE
INSTALLMENT PAYMENTS, THE COURT MAY DISMISS THE DEBTOR’S CASE.
[
] SCHEDULED FOR HEARING.
A hearing to consider the debtor’s “Application for Waiver of the Chapter 7 Filing Fee” shall be held
on __________________ at ________ am/pm at ________________________________________.
(address of courthouse)
IF THE DEBTOR FAILS TO APPEAR AT THE SCHEDULED HEARING, THE COURT MAY
DEEM SUCH FAILURE TO BE THE DEBTOR’S CONSENT TO THE ENTRY OF AN ORDER
DENYING THE FEE WAIVER APPLICATION BY DEFAULT.
BY THE COURT:
DATE: __________
__________________________
United States Bankruptcy Judge
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