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 Requesting Party] Name of Requestor_____________________________

[Name of Debtor(s)] Case Name___________________________________
[Case No.] Case No.____________________________________

[Street or P.O. Address] Address______________________________________
[City, State & Zip] _____________________________________________
[Telephone Number, incl. area code] Telephone No.(____)____________________________

AP No. [AP 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

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

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 Petition Schedules Statement of Financial Affairs 341 Meeting Notice Discharge No Distribution Report Chapter 13 Plan Date Filed Entry Number Number of Pages

______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:_____________________________

Amount Paid: _____________ Date Paid:________________

If picked up at Clerk's Office: Date Received: __________ Signature of Requestor/Agent:___________________________
[copyreqn ver. 11/1/03]