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Appearance Of Child Support Creditor Or Representative BTXN 005 - Texas
| Appearance Of Child Support Creditor Or Representative Form. This is a Texas form and can be used in Northern District Bankruptcy Court Federal . |
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BTXN 005 (rev. 1/99) UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF TEXAS In Re: Case No.: Debtor(s) APPEARANCE OF CHILD SUPPORT CREDITOR OR REPRESENTATIVE I certify, under penalty of perjury, that I am a child support creditor* of the debtor(s) named below (or the authorized representative of such child support cre ditor), with respect to the child support obligation set out below. __________________________________ __________________________________ Debtors Name Joint Debtors Name __________________________________ __________________________________ Debtors Social Security No./Tax ID No. Joint Debtors Social Security No./Tax ID No. __________________________________ __________________________________ Debtors Address Joint Debtors Address __________________________________ __________________________________ Signature of Child Support Representative Printed Name of Child Support Representative __________________________________ __________________________________ Organization Telephone Number __________________________________ __________________________________ Address Date Summary of Child Support Obligations Amount in arrears: $ __________________________________________________ ____________. Amount currently due on a continuing basis: $ _________________________ ________________. (please note if per week or per month) Complete the following if child support has been assigned. Amount of support which is owed under assignments: $ __________________ ________________. Amount owed primary child support creditor (balance not assigned): $ ______________________. Attach an itemized statement of account. * Child support creditor includes both creditor to whom the debtor has a primary obligation to pay child support as well as any entity to whom s uchsupport has been assigned, if pursuant to Section 402(a)(26) of the Social Security Act or if such debt has been assigned to the Federal Gov ernment orto any State or political subdivision of a State.
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