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Payment Cover Sheet - Iowa
| Payment Cover Sheet Form. This is a Iowa form and can be used in USBC Northern Federal . |
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UNITED STATES BANKRUPTCY COURT Northern District of Iowa PAYMENT COVER SHEET in Accordance with 11 U.S.C. Sec. 521(a)(1)(B)(iv) In re: Case No.: Debtor(s) Please check the appropriate box. For Debtor: o Payment advices (or other evidence of payment) are attached. o No payment advices (or other evidence of payment) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). o No payment advices (or other evidence of payment) attached for other reason, or some payment advices missing (please explain). For Joint Debtor, if applicable: o Payment advices (or other evidence of payment) are attached. o No payment advices (or other evidence of payment) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). o No payment advices (or other evidence of payment) 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: ___________ American LegalNet, Inc. www.FormsWorkFlow.com
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