Statement Of Social Security Number(s) (NYEB)
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Statement Of Social Security Number(s) (NYEB) Form. This is a New York form and can be use in Bankruptcy Court Federal.
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Tags: Statement Of Social Security Number(s) (NYEB), B21, New York Federal, Bankruptcy Court
B21 (Official Form 21) (12/07)
UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF NEW YORK
---------------------------------------------------------------x
In re:
Case No.
Chapter
Debtor(s)*
---------------------------------------------------------------x
AMENDED
STATEMENT OF SOCIAL SECURITY NUMBER(S)
(or other Individual Taxpayer Identification Number(s) (ITIN(s)))
1. Name of Debtor (enter Last, First, Middle):
(Check the appropriate box and, if applicable, provide the required information.)
Debtor has a Social Security Number and it is:
(If more than one, state all.)
Debtor does not have a Social Security Number but has an Individual Taxpayer Identification
Number (ITIN), and it is:
.
(If more than one, state all.)
Debtor does not have either a Social Security Number or an Individual Taxpayer Identification
Number (ITIN).
2. Name of Joint Debtor (enter Last, First, Middle):
(Check the appropriate box and, if applicable, provide the required information.)
Joint Debtor has a Social Security Number and it is:
(If more than one, state all.)
Joint Debtor does not have a Social Security Number but has an Individual Taxpayer Identification
Number (ITIN), and it is:
.
(If more than one, state all.)
Joint Debtor does not have either a Social Security Number or an Individual Taxpayer Identification
Number (ITIN).
I declare under penalty of perjury that the foregoing is true and correct.
X
Signature of Debtor
Date
Signature of Joint Debtor
Date
X
*Joint debtors must provide information for both spouses.
Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C.
ยงยง 152 and 3571.
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