Official Form B3B (Application AOB3B2) (10/05) APPLICATION FOR WAIVER OF CHAPTER 7 FILING FEE FOR INDIVIDUALS WHO CANNOT PAY THE FILING FEE IN FULL OR IN INSTALLMENTS In Re: Case No. Debtor(s) (If known) Part A. Family Size and Income 1. Including yourself, your spouse, and dependents you have listed or will list in Schedule I (Current Income of Individual Debtor(s)), how many people are in your family? (Do not include your spouse if you are separated AND are not filing a joint petition.) 2. Restate the following information that you provided, or will provide, on Line 16 of Schedule I. Attach a completed copy of Schedule I, if it is available. Total combined Monthly Income (Line 16 of Schedule I): 3. $ State the monthly net income, if any, of dependants included in Question 1 above. Do not include any income already reported in Item 2 above. If none, enter $0. $ 4. Add the “Total Combined Monthly Income” reported in Item 2 above to your dependants’ monthly net income from Item 3 above. $ 5. Do you expect the amount in Item 4 above to increase or decrease by more than 10% during the next six (6) months? Yes No Part B. Monthly Expenses 6. EITHER (a) attach a completed copy of Schedule J (Schedule of Monthly Expenses), and state your total monthly expenses reported on Line 18 of Schedule J, OR (b) if you have not yet completed Schedule J, provide an estimate of your monthly expenses. $ 7. Do you expect the amount in Item 6 above to increase or decrease by more than 10% during the next six (6) months? Yes No If yes, explain. American LegalNet, Inc. www.USCourtForms.com Official Form B3B (cont.) (Application) (10/05) Part C. Real and Personal Property EITHER (1) attach completed copies of Schedule A (Real Property) and Schedule B (Personal Property), OR (2) if you have not yet completed those schedules, provide the following information: 8. State the amount of cash you have on hand: 9. State below any money you have in savings, checking or other accounts in a bank or other financial institution. Bank or Other Financial Institution: $ Type of Account such as savings, checking, CD: Amount: $ $ 10. State below the assets owned by you. Do not list ordinary household furnishings and clothing. Home Address: Value: $ Amount owed on mortgages and liens $ Other Real Estate Address: Value: $ Amount owed on mortgages and liens $ Motor Vehicle(s) Model/Year Value: Amount owed: Model/Year Value: Amount owed: $ $ $ $ Other Description Value: Amount owed: $ $ American LegalNet, Inc. www.USCourtForms.com 11. State below any person, business, organization, or governmental unit that owes you money and the amount that is owed. Name of Person, Business or Organization that owes you money Amount Owed $ $ Part D. Additional Information 12. Have you paid an attorney any money for services in connection with this case, including the completion of this form, the bankruptcy petition, or schedules? Yes No If yes, how much have you paid? 13. $ Have you promised to pay or do you anticipate paying an attorney in connection with your bankruptcy case? Yes No If yes, how much have you promised to pay or anticipate paying? 14. $ Have you paid anyone other than an attorney (such as a bankruptcy petition preparer, paralegal, typing service, or another person) any money for services in connection with this case, including the completion of this form, the bankruptcy petition or schedules? Yes No If yes, how much have you promised to pay or anticipate paying? 15. $ Have you promised to pay or do you anticipate paying anyone other than an attorney (such as a bankruptcy petition preparer, paralegal, typing service, or another person) any money for services in connection with this case, including the completion of this form, the bankruptcy petition or schedules? Yes No If yes, how much have you promised to pay or anticipate paying? 16. $ Has anyone paid an attorney or other person or service in connection with this case on your behalf? Yes No If yes, explain. 17. Have you previously filed for bankruptcy relief during the last eight (8) years? Yes Case Number (if known) Year filed Location of filing No Did you obtain a discharge (if known) Yes No Don’t know Yes No Don’t know Yes No Don’t know 18. Please provide any other information that helps to explain why you are unable to pay the filing fee in installments. 19. I (we) declare under penalty of perjury that I (we) cannot currently afford to pay the filing fee in full or in installments and that the foregoing information is true and correct. Executed on: Date Signature of Debtor Date Signature of Joint Debtor American LegalNet, Inc. www.USCourtForms.com DECLARATION AND SIGNATURE OF BANKRUPTCY PETITION PREPARER (See 11 U.S.C. Section 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. Section 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. Sections 110(b), 110(h), and 342(b); and (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. Section 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor(s) notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required under that section. Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer Social Security No. (Required by 11 U.S.C. Section 110.) If the bankruptcy petition preparer is not an individual, state the name, title (if any), address and social security number of the officer, principal, responsible person, or partner sho signs the document. x Signature of Bankruptcy Petition Preparer Date Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer is not an individual: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form fo reach person. A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. Section 110; 18 U.S.C. Section 156. American LegalNet, Inc. www.USCourtForms.com