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Statement Of Social Security Numbers - Michigan

Statement Of Social Security Numbers Form. This is a Michigan form and can be used in USBC Western Federal .
 Fillable pdf Last Modified 11/12/2009
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Attorney/Debtor Name, Address, Phone, Fax, E-mail: For Court use only NOT TO BE FILED UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MICHIGAN In re: Case No. Chapter Debtor(s) STATEMENT OF SOCIAL SECURITY NUMBERS(S) 1. Name of Debtor (enter 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. 2. Name of Joint Debtor (enter 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. I declare under penalty of perjury that the foregoing is true and correct. X ________________________________________ ________________ Signature of Debtor Date X ________________________________________ ________________ Signature of 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. B21 12/03 American LegalNet, Inc. www.FormsWorkFlow.com
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