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Statement Under Penalty Of Perjury Concerning Payment Advices LBF 1007-6.1 - Colorado
| Statement Under Penalty Of Perjury Concerning Payment Advices Form. This is a Colorado form and can be used in Bankruptcy Court Federal . |
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Local Bankruptcy Form 1007-6.1 United States Bankruptcy Court _______________ District Of _______________ In re __________________________________________, [Set forth here all names including married, maiden, and trade names used by debtor within last 8 years.] Debtor ) ) ) ) ) Case No. ________________ ) Address ________________________________________ ) ) ________________________________________ ) Chapter ___________ ) Last four digits of Social-Security or Individual TaxPayer-Identification (ITIN) No(s).,(if any): ___________ ) ______________________________________________ ) Employer Tax-Identification (EIN) No(s).(if any): _____ ) _______________________________________________ ) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT UNDER PENALTY OF PERJURY CONCERNING PAYMENT ADVICES I*, , state as follows: I did not file with the court copies of some or all payment advices or other evidence of payment received within 60 days before the date of the filing of the petition from any employer because: Check applicable boxes: [ ] I was not employed during the period immediately preceding the filing of the above-referenced case, [ ] I was employed during the period immediately preceding the filing of the above referenced case but did not receive any payment advices or other evidence of payment from my employer within 60 days before the date of the filing of the petition; [ ] I am self-employed and do not receive any evidence of payment from an employer; [ ] Other (please provide explanation): ______________________________________. I declare under penalty of perjury that the foregoing statement is true and correct. Dated: ______________________ By: __________________________________ Signature of debtor _____________________________________ Printed name of debtor Home address Telephone number Facsimile number E-mail address * A separate form must be signed for each debtor. American LegalNet, Inc. www.FormsWorkFlow.com
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