Statement Under Penalty Of Perjury Concerning Payment Advices Due
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Statement Under Penalty Of Perjury Concerning Payment Advices Due Form. This is a West Virginia form and can be use in Bankruptcy Court Federal.
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Tags: Statement Under Penalty Of Perjury Concerning Payment Advices Due, West Virginia Federal, Bankruptcy Court
Form payadvic
UNITED STATES BANKRUPTCY COURT
Southern District of West Virginia
In Re: __________________________________
Debtor(s)
Case No.: _____________
Chapter:__
Judge: Ronald G. Pearson
STATEMENT UNDER PENALTY OF PERJURY CONCERNING
PAYMENT ADVICES DUE PURSUANT TO 11 U.S.C. SECTION 521(a)(1)(B)(iv)
I*,_______________________(Debtor's name), state that I did not file copies of all payment advices or other
evidence of payment received within 60 days before the date of the filing of the petition, by me from any employer
because:
___
(1)
I was not employed during the period immediately preceding the filing of the above−referenced
case ____________________________(state the dates that you were not employed);
___
(2)
I was employed during the period immediately preceding the filing of the above referenced case but
did not receive any payment advices or other evidence of payment from my employer within 60
days before the filing of the petition;
___
(3)
I am self employed and do not receive any evidence of payment;
___
(4)
Other (please
explain)_____________________________________________________________________
I declare under penalty of perjury that I have read the foregoing statements and that they are true and accurate to
the best of my knowledge, information and belief.
Dated this _______________day of ___________________________, 200__.
________________________________________________(Signature of Debtor)
* A separate form must be filed for each Debtor.
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