Free LBF - Statement of Social Security or Employee Identification Number - Illinois


File Size: 12.5 kB
Pages: 1
Date: January 24, 2006
File Format: PDF
State: Illinois
Category: Bankruptcy
Word Count: 78 Words, 665 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ilnb.uscourts.gov/forms/Official_Bankruptcy_Forms/LBF_Statement_SSNumber.pdf

Download LBF - Statement of Social Security or Employee Identification Number ( 12.5 kB)


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United States Bankruptcy Court Northern District of Illinois Eastern Division
In Re: ) ) ) ) ) Bankruptcy Case No.

Debtor

Statement of Social Security or Employee Identification Number

Name of claimant: Claimant's Social Security or EI Number:

______________________________ ______________________________

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

______________________________ Signature of Claimant Date

______________________________________________________________________________
Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. ยงยง 152 and 3571.

11-19-03