UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) Case No. _________________ INDIVIDUAL DEBTOR'S APPLICATION TO PAY FILING FEES IN INSTALLMENTS Debtor(s) In accordance with Fed. Bankruptcy Rule 1006, application is made for permission to pay all the fees for filing on the following terms: a. If a CHAPTER 7 CASE - $________ with the filing of the petition and the balance as follows: $_________ (at least $50) within 30 days, $_________ (at least $50) within 60 days, and $_________ (the balance of the fee) within 90 days from the entry date of the order allowing installment payments. b. If a CHAPTER 11 CASE - $________ (at least $405) with the filing of the petition and the balance as follows: $________ within 30 days and $________ within 60 days from the entry date of the order allowing installment payments. c. If a CHAPTER 12 CASE - $________ with the filing of the petition and the balance of $________ within 45 days from the entry date of the order allowing installment payments. d. If a CHAPTER 13 CASE - $_________ (at least $185) with the filing of the petition and the balance of $_________ within 45 days from the entry date of the order allowing installment payments. I certify that I am unable to pay all the filing fees except in installments. I further certify that I will not make any additional payment to an attorney or any other person for services in connection with this case until all filing fees are paid in full. I UNDERSTAND MY CASE MAY BE PROMPTLY DISMISSED, AND I MAY NOT RECEIVE A DISCHARGE OF MY DEBTS, IF I FAIL TO PAY ANY AMOUNT ON TIME. Dated: ____________ Signed: __________________________________________ Applicant Signed: ___________________________________________ Applicant Email Reminder: If you would like to receive an email reminder from the court regarding your payments, please complete this information: Debtor's email address: ________________________________________________________________________ (If applicable) Joint debtor's email address: ________________________________________________________ Note: You will receive an Order to Pay in Installments in the mail that lists each payment and when it is due. The Court will also attempt to send an email reminder, but whether or not you receive the reminder, you are responsible for making each payment on or before the due date. The Court cannot confirm an email address is accurate and will not resend an email that is undeliverable. 110 (12/1/13) American LegalNet, Inc. www.FormsWorkFlow.com