FORM 1007-1F (10/07) UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF OKLAHOMA IN RE: ____________________________, Debtor(s). PAYMENT ADVICES CERTIFICATION (NOTE: A separate form must be filed by each debtor in a joint case) Case No. ______________ Chapter ____ Pursuant to 11 U.S.C. § 521(a)(1)(B)(iv), a debtor shall file copies of all payment advices or other evidence of payment (such as paycheck stubs, direct deposit statements, employer's statement of hours and earnings) received from the debtor's employer within 60 days before the date the debtor filed his/her bankruptcy case (the "petition date").* I, _________________________________________ hereby state as follows: (debtor's name) (select one) G I have attached hereto, or previously filed with the Court, copies of all payment advices or other evidence of payment received from my employer(s) within 60 days before the petition date. Number of Employers: ________ Number of Payment Advices received: ________ Number of Payment Advices attached: ________ Period Covered:__________________________________________________ (If period covered is less than 60 days, attach an explanation.) If the attached payment advices do not cover the entire 60-day period, describe any "other evidence of payment" that you intend to rely upon. ______________________________________________________. G I received payment advices from an employer(s) during the 60 days before the petition date but have not yet located or obtained copies of all of the payment advices. I understand that if I do not file all payment advices or other evidence of payment within 45 days from the petition date, my bankruptcy case may be dismissed. Number of Employers: ________ Number of Payment Advices attached: ________ Period Covered: ______________________ Number of missing Payment Advices: _______ Dates of missing Payment Advices:________ G I did not receive any payment advices or other evidence of payment from any employer at any point during the 60 days before the petition date. (If you were employed, attach an explanation of why you did not receive any payment advices from your employer.) I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge, information and belief. _______________________________________ s/ Date: ____________________ (Signature of Debtor) Print name: __________________________ * In order to protect the debtor's privacy, all but the last four digits of the Debtor's social security number and financial account number should be redacted from any payment advice. References to dates of birth should contain only the year and names of any minors should be redacted or include only initials. American LegalNet, Inc. www.FormsWorkFlow.com