IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor(s) : : : : : : : : : : : Bankruptcy No. Chapter Movant (s) v. Related to Document No. Respondent(s) NOTIFICATION OF DEBTOR'S SOCIAL SECURITY NUMBER Name of employer or other party subject to wage attachment: Debtor's name: Debtor's nine-digit Social Security number: Debtor's address: Debtor's phone number: - This notification is accompanied by a Wage Attachment Order issued by a United States Bankruptcy Judge regarding attachment of the debtor's wages. The debtor's Social Security number is being provided to assist in complying with the court order. NOTE: BECAUSE THIS NOTICE DISCLOSES THE DEBTOR'S FULL SOCIAL SECURITY NUMBER, IT IS TO BE MAILED TO THE EMPLOYER BUT SHALL NOT BE FILED WITH THE BANKRUPTCY COURT. DATE: ______________________ _____________________________________________ Signature: Attorney for Debtor(s) [or pro se Debtor(s)] _____________________________________________ (Typed Name) _____________________________________________ (Address) _____________________________________________ (Phone No.) _____________________________________________ List Bar I.D. and State of Admission PAWB Local Form 12 (07/13) American LegalNet, Inc. www.FormsWorkFlow.com