Arkansas > Federal > USBC Eastern And Western
Statement Of Social Security Number(s) 21 - Arkansas
| Statement Of Social Security Number(s) Form. This is a Arkansas form and can be used in USBC Eastern And Western Federal . |
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OFFICIAL FORM 21 UNITED STATES BANKRUPTCY COURT EASTERN AND WESTERN DISTRICTS OF ARKANSAS In re ) ) ) ) Debtor(s) ) ) Address: ) ) ) Last four digits of Social Security No(s): ) all of Employer's Tax Identification No(s) [if any]: ) ) ) ___________________________________________ 1. Name of Debtor: (Last, First, Middle) Case No. Chapter STATEMENT OF SOCIAL SECURITY NUMBER(S) (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. 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. I declare under penalty of perjury that the foregoing is true and correct. ________________________________________ Signature of Debtor ____________________ Date ________________________________________ 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 American LegalNet, Inc. www.FormsWorkflow.com
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