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Statement Of Pro Se Debtors LBF 2016-4 - Pennsylvania
|Statement Of Pro Se Debtors Form. This is a Pennsylvania form and can be used in USBC Eastern Federal .||
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LOCAL BANKRUPTCY FORM 2016-4 STATEMENT OF PRO SE DEBTOR(S) Debtor's Name _________________________________ Address________________________________________ Telephone Number (home) ________________________ Telephone Number (work) ________________________ Case No._____________________________ Chapter of Case______________________ Date Case Filed_____________________ Date this Form Submitted _____________ 1. List the name, address, and telephone number of any person or business assisting you in filing or preparing papers for this case: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ 2. State how you were referred to the person or business named above or the source of advertisement you responded to. _____________________________________________________________ 3. a. b. c. Total fee charged by person or business named above $ __________ Amount of fee paid as of the date you filed bankruptcy $ _________ Did the preparer tell you the amount of court costs that must be paid to file your case? YES NO (circle one) 4. Were various chapters or types of bankruptcy explained to you? YES NO (circle one) Other Comments _____________________________________________________________ 5. Did the preparer explain to you that you have the right to claim certain property as exempt? YES 6. NO (circle one) Did the preparer give you a copy of the papers he prepared for you? YES NO (circle one) _______________________________ Signature of Debtor(s) 2002 © American LegalNet, Inc.