B202 (Form 202) (08/07) United States Bankruptcy Court ____________________ District of ____________________ In re _________________________ Case Number Chapter _______________________ _______________________ STATEMENT OF MILITARY SERVICE The Servicemembers’ Civil Relief Act of 2003, Pub. L. No. 108-189, provides for the temporary suspension of certain judicial proceedings or transactions that may adversely affect military servicemembers, their dependents, and others. Each party to a bankruptcy case who might be eligible for relief under the act should complete this form and file it with the Bankruptcy Court. IDENTIFICATION OF SERVICEMEMBER ‘ Self (Debtor, Codebtor, Creditor, Other) ‘ Non-Filing Spouse of Debtor (name)________________________________________ ‘ Other (Name of servicemember)__________________________________________ (Relationship of filer to servicemember)_______________________________ (Type of liability) ________________________________________________ TYPE OF MILITARY SERVICE U.S. Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) or commissioned officer of the Public Health Service or the National Oceanic and Atmospheric Administration (specify type of service) _____________________________________________________________ ‘ Active Service since ____________________________________________(date) ‘ Inductee - ordered to report on ____________________________________________(date) ‘ Retired / Discharged ____________________________________________(date) U.S. Military Reserves and National Guard ‘ Active Service since ____________________________________________(date) ‘ Impending Active Service -orders postmarked _______________________________(date) Ordered to report on ____________________________________________(date) ‘ Retired /Discharged ____________________________________________(date) U.S. Citizen Serving with U.S. ally in war or military action (specify ally and war or action) ______________________________________________________________________ ‘ Active Service since ____________________________________________(date) ‘ Retired/Discharged ____________________________________________(date) DEPLOYMENT ‘ Servicemember deployed overseas on _______________________________________(date) Anticipated completion of overseas tour-of-duty ______________________________(date) SIGNATURE ____________________________________ ___________________________ Date ____________________________________ (print name) This statement is for information use only. Filing this statement with the Bankruptcy Court does not constitute an application for or invoke the benefits and relief available under the Servicemembers’ Civil Relief Act of 2003. American LegalNet, Inc. www.FormsWorkflow.com