Payment Advices Cover Sheet {VTB-B}

VTB Form B 0 4 /2018 See Vt. LBR 1007 - 1(d); 11 U.S.C. 247 521(a)(1)(B)(iv) UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT In re: , Chapter Debtor (s) . Case # P AYMEN T A DVICE S C OVE R S HEET Check the Appropriate Box. For Debtor: Payment a dvices (pay stubs) are a ttached. Number of p ages a ttached: Period c overed : through E xplain any gaps: Number of e mployers f rom w hom d ebtor r eceived p ayment a dvices d uring the 60 d ays p rior to f iling t he b ankruptcy p etition: No p ayment a dvices are a ttached because the debtor had no inco me from any employer during the 60 days prior to filing the bankruptcy petition. No p ayment a dvices are a ttached , or some payment advices missing , for some other reason . Please e xplain: For Joint Debtor, if applicable: Payment a dvices (pay stubs) are a ttached. Number of p ages a ttached: Period c overed : through E xplain any gaps: Number of e mployers f rom w hom d ebtor r eceived p ayment advices d uring the 60 d ays p rior to f iling t he b ankruptcy p etition: No p ayment a dvices are attached because the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition. No p ayment a dvices are a ttached , or some payment advices missing , for some other reason . Please e xplain: American LegalNet, Inc. www.FormsWorkFlow.com VTB Form B 0 4 /2018 See Vt. LBR 1007 - 1(d); 11 U.S.C. 247 521(a)(1)(B)(iv) D EBTOR S D ECLARATION UNDER P ERJURY I declare under penalty of perjury that I have read the p ayment a dvices c over s heet and the attached payment advices, consisti n g of sheets, numbered 1 through , and that they are true and correct to the best of my knowledge, information , and b elief. Signature of Debtor: Date: Signature of Joint Debtor : Date American LegalNet, Inc. www.FormsWorkFlow.com