Payment Advices Cover Sheet {NYEB PACS}

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NEW YORK PAYMENT ADVICES COVER SHEET in Accordance With 11 U.S.C. Sec. 521(a)(1)(B)(iv) In re: Case No. Chapter: Debtor(s) Please Check the Appropriate Box. For Debtor: Payment Advices are Attached. · · · Number of Payment Advices Attached: Period Covered: (If period covered is less than 60 days or 8 weeks, attach an explanation) Number of Employers From Whom Debtor Received Payment Advices During the 60 Days Prior to Filing the Bankruptcy Petition: For Joint Debtor, if applicable: Payment Advices are Attached. · · · Number of Payment Advices Attached: Period Covered: (If period covered is less than 60 days or 8 weeks, attach an explanation) Number of Employers From Whom Debtor Received Payment Advices During the 60 Days Prior to Filing the Bankruptcy Petition: For Debtor: No Payment Advices are Attached (the debtor had no income from any employer during the 60 Days Prior to Filing the Bankruptcy Petition). No Payment Advices are Attached for Some Other Reason. (Attach an explanation) For Joint Debtor, if applicable: No Payment Advices are Attached (the debtor had no income from any employer during the 60 Days Prior to Filing the Bankruptcy Petition). No Payment Advices are Attached for Some Other Reason. (Attach an explanation) I declare under penalty of perjury that I have read this Payment Advices Cover Sheet and the attached payment advices, consisting of sheets, numbered 1 through , and that they are true and correct to the best of my knowledge, information and belief. Signature of Debtor: Signature of Joint Debtor: Payment Advices Cover Sheet 4/11/06 Date: Date: Deputy Clerk's Initials: American LegalNet, Inc. www.USCourtForms.com