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Statement Of Domestic Support Obligation(s) LBF-30 - Montana

Statement Of Domestic Support Obligation(s) Form. This is a Montana form and can be used in Bankruptcy Court Federal .
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Mont. LBF 30. STATEMENT OF DOMESTIC SUPPORT OBLIGATION(S) [Mont. LBR 4002-1(e)] Name of Attorney Office Mailing Address Telephone Number Facsimile Number E-Mail Address State Bar I.D. Number (Attorney for Debtor(s)) UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF MONTANA ) Case No. ) ) Debtor(s). ) _____________________________________________________________________________ STATEMENT OF DOMESTIC SUPPORT OBLIGATION(S) _____________________________________________________________________________ [If filing jointly, information for both spouses must be provided on this form] In re: Pursuant to Mont. LBR 4002-1(e), the undersigned hereby provides this Statement of Domestic Support Obligation(s), as defined in 11 U.S.C. § 101(14A). 1. Debtor's name (enter full name): ____________________________________________ 2. Does Debtor have a domestic support obligation: ____ yes ____ no. If yes, please fill out the rest of this form. If no, do not fill out the rest, but sign where indicated below. 3. Debtor's employer and employer's address: ___________________________________ 4. Name, address, phone number, employer's name, and address of employer for any person responsible with the Debtor for the support: _________________________________________________________________________ _________________________________________________________________________ 5. Name, address and phone number for the holder of the claim of support: _________________________________________________________________________ _________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com [If the Debtor does not know the whereabouts of the former spouse, this fact should be affirmatively stated above, but the address for the support collection agency must be provided.] ______________________________________________________________________________ AS OF THE DATE OF FILING OF THE BANKRUPTCY PETITION: 1. Amount of support obligation: $__________ per ___________ [i.e. month, week, etc.] 2. Term of support obligation: from _______________ until _____________________ 3. Amount that the domestic support obligation is in arrears: $ ____________________ 4. Court name and jurisdiction in which order of support was issued: _______________________________________________________________________ 5. Court Case No. ___________________ 6. Name and address of State Child Support Enforcement Agency involved in such claim: _________________________________________________________________________ ___________________________________________________________________________ I/We declare under penalty of perjury that the foregoing is true and correct. ___________________________________ Signature of Debtor __________________ Date ____________________________________ Signature of Co-Debtor ____________________ Date Penalty for making a false statement: Fine up to $250,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571 American LegalNet, Inc. www.FormsWorkFlow.com
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