B 132 (11/03)
United States Bankruptcy Court
_____________ District of _______________ APPLICATION FOR SEARCH OF BANKRUPTCY RECORDS
Name of individual or business that is the subject of the search: Social Security No. or Employer Tax I.D. No. of Subject:
Please search your records for the following information regarding the individual or business named above: pend ing or closed bankruptcy cases in this district; pending o r closed ad versary proc eedings; judgments/evidence of satisfaction of judgments; and other [d escribe briefly] Please search for the period from _____________________________to ________________________________. A fee of $26.00 is charged for each name or item searched. Payment by check or money order must be enclosed. Please do not send cash through the m ail. Name, add ress, and phone number of the person requesting the search:
CERTIFICATE OF SEARCH
The undersigned clerk hereby certifies the following results of a diligent search of the records of the court: [Check only the items for which a search was requested and a fee paid.] A. Bankruptcy Cases: 1. None found. 2. Case filed on ____________________________. (date) Voluntary Involuntary Pending Closed on ____________________________. (date) Discharge granted on ____________________________. (date) B. Adversary Proceedings: 1. None found. 2. Subject is a party to the following proceeding: ____________________________________________ v. __________________________________________________
(Plaintiff) (Defendant)
Adversary Proceeding Number ________________________________, filed on ________________________________. (date) Pending Closed on ___________________________________________. (date) Disposition: Dismissed on ______________________________________________________________________ (date) Final Judgment entered on ____________________________________________________________ (date) Case Number of Related Bankruptcy Case _______________________________________________________________. _______________________________________________________________
Clerk of the Bankruptcy Court
_______________________________________________
Date
By: __________________________________________________________
Deputy Clerk