NATIONAL ARCHIVES AND RECORDS ADMINISTRATION ROCKY MOUNTAIN REGION P.O. BOX 25307 DENVER, CO 80225 U.S. BANKRUPTCY COURT FOR THE DISTRICT OF UTAH BANKRUPTCY RECORDS ORDER FORM FOR FACSIMILE AND/OR MAIL ORDER COPIES Case Location Information: Case Name______________________________________________________Case Number___________________ FRC Box #________ Accession #___________________________________________FRC Location #__________________________________________________ Select one of the following options, then, completely fill out Requestor Information: Fax Package Information: (Copies will be faxed) ( ) Option 1. “The Package” - includes documents or their equivalent: Discharge, Debtor Voluntary Petition, selected schedules (list of creditors and amendments). No substitutions. 25 page limit. Cost: $10.00 ( ) Option 2. “Whole File” - includes all documents in a case file up to 70 pages. No designation of pages in larger cases allowed. Cost: $35.00 Requestor Information: Name:_____________________________________ Address:___________________________________ Mail-Order Package Information: ( ) Option 3. “The Package” - Includes the same features as Option 1 to the left. Cost: $10.00 ( ) Option 4. “The Package with Certification” same as Option 1, but also includes certification of records. Cost: $16.00 ( ) Option 5. “Whole File” - includes all documents in the case file. (We will call to provide an estimate.) Cost: $0.50 per page. ( ) Option 6. “Whole File with Certification” includes all documents in a case file plus a certification of records. (We will call to provide and estimate). Cost: $0.50 per page plus $6.00 for Certification of Records. City, State, Zip:______________________________ Daytime Phone:______________________________ Additional Information FAX Number:_______________________________ *Fax this form to the National Archives and Records Administration at (303) 407-5761 or if enclosing check or money order, mail to NARA at the address at the top of this form. Payment must be made payable to the National Archives Trust Fund or NATF. Credit Card #:_______________________________ Expiration Date:_____________________________ Visa ( ) Mastercard ( ) American Express ( ) Discover ( ) No Other Cards Accepted “I approve up to : $50.00 without Confirmation”. $75.00 *Complete the Fed Ex portion of this form if that service is requested. $100.00 Fed Ex Priority Service? ($25 charge) 2 Yes No If “Yes”, use credit card # above? Yes *We will try faxing 3 times only. It will take 2 to 5 days to completely process your request. Duplicate Faxing may incur additional charges. No or: FED EX Account #:__________________________ 10/05 6/04