Free Microsoft Word - localform_new - Massachusetts

United States Bankruptcy Court District of Massachusetts


In Re: Chapter: Case Number:



APPLICATION TO PAY FILING FEE IN INSTALLMENTS
1. 2. 3. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the Filing Fee amounting to $ in installments. I certify that I am unable to pay the Filing Fee except in installments. I certify further that I have not paid any money or transferred any property to an attorney for services in connection with this case and that I will neither make any payment nor transfer any property for services in connection with this case until the filing fee is paid in full. 4. I propose the following terms for the payment of the Filing Fee.* Check one with the filing of the petition, or: $ $ $ on or before on or before on or before

*The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided that the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2).




5. I understand that if I fail to pay any installment when due my bankruptcy case may be dismissed and I may not receive a discharge of my debts.


Signature of Attorney (Date)



Signature of Debtor (Date)

CERTIFICATION AND SIGNATURE OF NONATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)
I certify that I am a bankruptcy petition preparer as defined in U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. I also certify that I will not accept money or any other property from the debtor before the filing fee is paid in full.



Signature of Joint Debtor (Date) In joint case, both spouses must sign


Social Security Number Names and Social Security Numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. Signature of Bankruptcy Petition Preparer ­ (Date) Printed or typed Name of Bankruptcy Petition Preparer

A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both., 11 U.S.C. § 110; 18 U.S.C. § 156.