COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. BTXN 006 (4/27/04) UNITED STATES BANKRUPTCY COURT : Calendar No. NORTHERN DISTRICT OF TEXAS : Plaintiff(s) In Re § § § § -against- JUDICIAL SUBPOENA : Case No. Debtor(s) : : Defendant(s) : APPLICATION TO PAY FILING FEES IN INSTALLMENTS ...................................................... In accordance with Federal Rule of Bankruptcy Procedure 1006(b)(1), an individual may file an Application to Pay Filing Fee in Installments at the time the petition is filed. In accordance with Local Rule 1006.1, an individual who files an application to pay a filing fee in installments without the initial installment payment set forth below, THE PEOPLE OF THE STATE OF NEW YORK shall be denied. TO (A) In Chapter 7, 12 and 13 cases, a $50.00 minimum payment is required (B) In a Chapter 11 case, a $100.00 minimum payment is required The balance is to be paid in three (3) payments, due every thirty (30) days from the date the petition was GREETINGS:period to pay the filing fee is not to exceed one hundred and twenty (120) days. filed. The time I certify that I am unable to pay the all business and excuses being laid aside, you and each any WE COMMAND YOU, that filing fee except in installments. I further certify that I have not paidof you attend before money to or transferred any property to an attorney or any otherthe in connection with this case or the Honorable at person for services Court in connection with any other pending case and that I will neither make any payment nor transfer any property for located at County of services in connection withthe case until the filing fee is paid , 20 the in full. , at in room , on day of o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the I understand that entry of my discharge [or confirmation of any plan] will be delayed until the filing fee is paid in full or, if not paid, that my case will be dismissed without further notice. Dated: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Signed: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Applicant If of document is prepared by a result this your failure to comply. NON-ATTORNEY BANKRUPTCY PETITION PREPARER, certification printed Witness, Honorable on page 2 must be completed. Court in County, , one of the Justices of the Signed: day of Joint Applicant , 20 DECLARATION BY ATTORNEY CONCERNING PAYMENT OF FILING FEES (Attorney must for above and type name I have not been paid any money nor accepted any transfer of property as paymentsign my services and will below) not do so until the fees have been paid in full. I have made the Applicant(s) aware that the case will be dismissed if the fee is not paid when due. Attorney(s) for Dated: Attorney for Debtor(s) Office and P.O. Address Form of payment: Please do not mail cash. Money orders or certified checks only; personal checks of the debtor will not be accepted. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com , COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. BTXN 006 (4/27/04) : CERTIFICATION AND SIGNATURE OFJUDICIAL Plaintiff(s) NON-ATTORNEY BANKRUPTCY PETITION PREPARER -against(See 11 U.S.C. § 110) : SUBPOENA I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document : for compensation, and that I have provided the debtor with a copy of this Application to Pay Filing Fees in Installments. I also certify that I will not accept money or any other property from the debtor before the filing fee is : paid in full. Defendant(s) : ...................................................... Printed or Typed Name of Bankruptcy Petition Preparer 110(c).) Social Security No. (Required by 11 U.S.C. § THE PEOPLE OF THE STATE OF NEW YORK TO Firm Name, if any GREETINGS: (Address) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at CountyState, ZIP Code) of (City, in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. If more than one person prepared this document, attach additional signed sheets conforming the Justices Witness, Honorable , one of to the appropriate Official Form for each person. Court in County, day of of the , 20 (Attorney must sign above and type name below) Signature of Bankruptcy Petition Preparer Date Attorney(s) for 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. § 110; 18 U.S.C. § 156. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com