UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII
Name of Debtor or Joint Debtor (Complete for each individual): Case No.:
(if known)
Chapter 7
"341 DECLARATION" CHAPTER 7 DEBTOR'S DECLARATION REGARDING PAYMENT ADVICES, TAX RETURNS, AND DOMESTIC SUPPORT OBLIGATIONS
Instructions: 1. Complete this form only if: You are not submitting a copy of your most recent tax return to the Trustee. You are not submitting all your payment advices (pay stubs) for the 60day period before you filed your bankruptcy petition. You are obligated to pay any type of domestic support obligation (child support, alimony, etc.) to an individual or a governmental unit.
2. Do not file this with the court. Mail this declaration to the Trustee at least 7 days prior to the ยง 341 meeting of creditors. If you have an attorney, your attorney may be able to transmit your declaration electronically. Declaration Under Penalty of Perjury. The undersigned states the following under penalty of perjury. A. Payment Advices (or other evidence of payment such as wage statements, pay stubs, etc.) I am not submitting payment advices received from my employer during the 60 days before the date of filing of my bankruptcy petition because: I was not employed during these dates: from ____________________ to ____________________. I was employed but have not received any payment advices or other evidence of payment from my employer during the 60day period before filing my petition. I am selfemployed and do not receive any evidence of payment from an employer. Other reason [Attach explanation if more space needed]: B. Federal Income Tax Return or Transcript I am not submitting my federal income tax return or transcript for the most recent tax year ending immediately before the date of filing of my bankruptcy petition because: I had insufficient gross income to require the filing of a federal tax return for tax year: ___________. My income for that tax year was: $__________________. Other reason [Attach explanation if more space needed]: C. Domestic Support Obligation(s) (child support, alimony, obligations under divorce agreement, etc.) I have one or more domestic support obligations requiring payment to an individual or governmental unit. The name and address of each payee is: Date: ____________________ /s/____________________________ Signature of Debtor
hib_5217dec 06/08