Form B3 (Official Form 3) (9/97)
Form 3. APPLICATION AND ORDER TO PAY FILING FEE IN INSTALLMENTS [Caption as in Form 16B.] APPLICATION TO PAY FILING FEE IN INSTALLMENTS
1. 2. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the Filing Fee amounting to $______________ in installments. I certify that I am unable to pay the Filing Fee except in installments.
3. I further certify that I have not paid any money or transferred any property to an attorney for services in connection with this case and that I will neither make any payment nor transfer any property for services in connection with this case until the filing fee is paid in full. 4. I propose the following terms for the payment of the Filing Fee.* With the filing of the petition, or On or before ______________ $ _____________________ on or before ________________________________________ $ _____________________ on or before ________________________________________ $ _____________________ on or before ________________________________________ * The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2). I understand that if I fail to pay any installment when due my bankruptcy case may be dismissed and I may not receive a discharge of my debts. __________________________________________________________ Signature of Debtor Date (In a joint case, both spouses must sign.) __________________________________________________________ Signature of Joint Debtor (if any) Date $ _____________________ Check one
5.
___________________________________________ Signature of Attorney Date ___________________________________________ Name of Attorney
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. I also certify that I will not accept money or any other property from the debtor before the filing fee is paid in full. ___________________________________________________ Printed or Typed Name of Bankruptcy Petition Preparer ________________________________ ________________________________ Address Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: __________________________ Social Security No.
If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.
x__________________________________________________ Signature of Bankruptcy Petition Preparer
_____________________ Date
A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
Form B3 continued (9/97)
UNITED STATES BANKRUPTCY COURT ______________________ DISTRICT OF _____________________
In re _______________________________________, Debtor
Case No. ___________________
Chapter _____________________
ORDER APPROVING PAYMENT OF FILING FEE IN INSTALLMENTS
IT IS ORDERED that the debtor(s) may pay the filing fee in installments on the terms proposed in the foregoing application. IT IS FURTHER ORDERED that until the filing fee is paid in full the debtor shall not pay any money for services in connection with this case, and the debtor shall not relinquish any property as payment for services in connection with this case.
BY THE COURT
Date: ____________________
__________________________________________ United States Bankruptcy Judge