Free Form 21 - Statement of Social Security Number - Colorado

UNITED STATES BANKRUPTCY COURT District of Colorado
In re BANKRUPTCY NO. CHAPTER Debtor(s). STATEMENT OF SOCIAL SECURITY NUMBER(S) 1. Name of Debtor (Last, First, Middle)

Check the appropriate box and, if applicable, provide the required information.

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2.

Debtor has a Social Security Number and it is: Debtor does not have a Social Security Number.

Name of Joint Debtor (Last, First, Middle)

Check the appropriate box and, if applicable, provide the required information.

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Joint Debtor has a Social Security Number and it is: Joint Debtor does not have a Social Security Number.

I declare under penalty of perjury that the foregoing is true and correct. Signed: Date:

(Debtor)

Signed:

(Joint Debtor)

Date:

Official Form 21