Payment Advice
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Payment Advice Form. This is a New York form and can be use in Bankruptcy Court Federal.
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Tags: Payment Advice, O521C, New York Federal, Bankruptcy Court
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF NEW YORK
In re
[Set forth here all names including married, maiden, and trade
names used by debtor within last 8 years.]
Debtor
Employer’s Tax Identification No(s). [if any]
Last four digits of Social Security No(s):
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Case No.
Chapter
For Debtor:
Payment advices are attached
Payment advices are not attached because debtor had no income from any employer during the 60
days prior to filing the bankruptcy petition.
Payment advices are not attached because debtor:
receives disability payments
is unemployed and does not receive unemployment compensation
receives Social Security payments
receives a pension
does not work outside the home
is self employed
other, please explain
Schedule I, Line 1 Income
Occupation as listed on Schedule I
For Joint Debtor, if applicable:
Payment advices are attached
Payment advices are not attached because debtor had no income from any employer during the 60
days prior to filing the bankruptcy petition.
Payment advices are not attached because debtor:
receives disability payments
is unemployed and does not receive unemployment compensation
receives Social Security payments
receives a pension
does not work outside the home
is self employed
other, please explain
Schedule I, Line 1 Income
Occupation as listed on Schedule I
I declare under penalty of perjury that I have read this Payment Advices Cover Sheet and the attached
payment advices, consisting of ___ sheets, and that they are true and correct to the best of my
knowledge, information and belief.
Signature of Debtor:
Date:
Signature of Joint Debtor: :
Date:
O:§521C(03/02/2006)
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