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Statement Of Social Security Number(s) (NYEB) B21 - New York
| Statement Of Social Security Number(s) (NYEB) Form. This is a New York form and can be used in Eastern District Bankruptcy Court Federal . |
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B21 (Official Form 21) (12/07) UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NEW YORK ---------------------------------------------------------------x In re: Case No. Chapter Debtor(s)* ---------------------------------------------------------------x AMENDED STATEMENT OF SOCIAL SECURITY NUMBER(S) (or other Individual Taxpayer Identification Number(s) (ITIN(s))) 1. Name of Debtor (enter Last, First, Middle): (Check the appropriate box and, if applicable, provide the required information.) Debtor has a Social Security Number and it is: (If more than one, state all.) Debtor does not have a Social Security Number but has an Individual Taxpayer Identification Number (ITIN), and it is: . (If more than one, state all.) Debtor does not have either a Social Security Number or an Individual Taxpayer Identification Number (ITIN). 2. Name of Joint Debtor (enter Last, First, Middle): (Check the appropriate box and, if applicable, provide the required information.) Joint Debtor has a Social Security Number and it is: (If more than one, state all.) Joint Debtor does not have a Social Security Number but has an Individual Taxpayer Identification Number (ITIN), and it is: . (If more than one, state all.) Joint Debtor does not have either a Social Security Number or an Individual Taxpayer Identification Number (ITIN). I declare under penalty of perjury that the foregoing is true and correct. X Signature of Debtor X Signature of Joint Debtor Date Date *Joint debtors must provide information for both spouses. Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. ยงยง 152 and 3571. American LegalNet, Inc. www.FormsWorkFlow.com
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