Free Request for Various Documents - Virginia

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA OFFICE OF THE CLERK


[Date of Request] Date of Request ______________________________ [Name of Debtor(s)] Case Name__________________________________ [Case No.] Case No.____________________________________ [AP No.] AP No. ____________________________________

[Name of Requesting Party] Name of Requestor_____________________________ [Street or P.O. Address] Address______________________________________

[City, State & Zip] _____________________________________________
[Telephone Number, incl. area code] Telephone No.(____)____________________________

Request for Certified Copies or Government Agency Photocopies
Check one:
_____Certified Copies. Identify document(s) $9.00 per document plus $ .50 per page copy fee ______ Search

[Descr. of Document(s)] to be certified: ______________________________

Fee - $26.00 if request made other than in person
[Total Amount Due] Amount Due $________________________

For the above items, make check payable to Clerk, U.S. Bankruptcy Court.

The above document requests are normally completed and available for pickup after 10:00 a.m. the next business day following the date of request. Please indicate at the bottom of this form your preferred method for receiving these documents upon completion of your request by the Clerk's Office. [PHOTOCOPY REQUESTS FOR GOVERNMENT AGENCIES ONLY: Will be processed within two business days following request] Document Description Date Filed Entry Number Number of Pages Petition Schedules Statement of Financial Affairs 341 Meeting Notice Discharge No Distribution Report Chapter 13 Plan

_______To be mailed. A self-addressed, stamped envelope of adequate size is attached to this request. _______To be picked up at the Clerk's Office. Requests not picked up within 10 days will be destroyed. FOR OFFICE USE ONLY: Date Requestor Notified:____________________________ Date Mailed/Picked Up:_____________________________ If picked up at Clerk's Office: Date Received: __________ Signature of Requestor/Agent:___________________________
[req4docr ver. 6/1/05]

Amount Paid: _____________ Date Paid:________________

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