Application For Payment Of Debtor Refund {F76} | Pdf Fpdf Doc Docx | New York

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Application For Payment Of Debtor Refund {F76} | Pdf Fpdf Doc Docx | New York

Application For Payment Of Debtor Refund {F76}

This is a New York form that can be used for Northern District within Federal, Bankruptcy Court.

Alternate TextLast updated: 3/30/2017

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UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF NEW YORK In re [Set forth here all names including married, maiden, and trade names used by debtor within last 6 years.] , Debtor(s). Social Security No(s). Employer's Tax Identification No(s). [if any] and all ) ) ) ) ) ) ) ) ) ) ) Case No. Chapter 13 APPLICATION FOR PAYMENT OF DEBTOR REFUND of (Name of Debtor) (Address and Telephone Number) , and (Name of Joint Debtor, if applicable) of , being duly sworn, (Address and Telephone Number) affirms as follows: 1. 2. I1 am the debtor named in the caption above. The Chapter 13 Trustee previously attempted to remit a refund owing to applicant but when unable to do so as a result of an out-dated mailing address, paid into the Court the sum of $ on or about . I have attached a photocopy of my current driver's license. I have attached a signed W-9 Request for Taxpayer Identification Number and Certification. 3. 4. 1 "I" shall be read as "we" when joint debtors are involved. F:76(05/27/2015) American LegalNet, Inc. www.FormsWorkFlow.com 5. 6. The right to this refund has not been sold or assigned. I am unaware of any dispute regarding the monies held by the Court. Based upon the foregoing and the attached proof of identity, I request that the Clerk of the Court pay to _ (Debtor [and Joint Debtor if applicable]) the sum of $ . xxx-xx(Signature of Debtor (Last four digits of social security number) xxx-xx(Signature of Joint Debtor, if applicable) (Last four digits of social security number) SUBSCRIBED AND SWORN to before me this day of Affix Seal ___________________________________ Notary Public Required Attachments: (1) Photocopy of Driver's License (include both if two claimants); (2) Affidavit of Service of Mailing to United States Attorney for the N.D.N.Y.; and (3) W-9 Request for Taxpayer Identification Number and Certification. F:76(05/27/2015) American LegalNet, Inc. www.FormsWorkFlow.com

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