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Statement Of Social Security Number (California Southern District) B21 - California
| Statement Of Social Security Number (California Southern District) Form. This is a California form and can be used in General USBC Southern Federal . |
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B 21 [12/01/07] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. STATEMENT OF SOCIAL SECURITY NUMBER(S) (or other Individual Taxpayer-Identification Number(s) (ITIN(s)) 1. Name of Debtor (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 (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 Date X Signature of Joint Debtor 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. B 21 American LegalNet, Inc. www.FormsWorkflow.com
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