UNITED STATES BANKRUPTCY COURT Western District of Wisconsin PAYMENT ADVICES COVER SHEET in Accordance with 11 U.S.C. Sec. 521(a)(1)(B)(iv) In re: ____________________________________ Debtor(s) Case No.: ________________ Please check the appropriate box. For Debtor: G Payment advices (pay stubs) are attached. G No payment advices (pay stubs) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). G No payment advices (pay stubs) attached for other reason, or some payment advices missing ( please explain). _______________________________________ ________________________________________________________________________ For Joint Debtor, if applicable: G Payment advices (pay stubs) are attached. G No payment advices (pay stubs) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). G No payment advices (pay stubs) attached for other reason, or some payment advices missing ( please explain). _______________________________________ ________________________________________________________________________ I declare under penalty of perjury that I have read this payment advices cover sheet and the attached payment advices, consisting of ______ sheets, numbered 1 through _____, and that they are true and correct to the best of my knowledge, information and belief. Signature of Debtor: _________________________________ Date: ___________ Signature of Joint Debtor: _________________________________ Date: ___________ March 2006 Print Save As Reset American LegalNet, Inc. www.FormsWorkflow.com