Free Form 21 - Statement of Social Security Number - Nebraska

UNITED STATES BANKRUPTCY COURT DISTRICT OF NEBRASKA

In Re:

Debtor(s)

) ) ) ) )

BK

STATEMENT OF SOCIAL SECURITY NUMBER(S)

1.

Name of Debtor (enter Last, First, Middle): ____________________________________ (Check the appropriate box and, if applicable, provide the required information.) 9 Debtor has a Social Security Number and it is: __ __ __ - __ __ - __ __ __ __ (If more than one, state all.) 9 Debtor does not have a Social Security Number.

2.

Name of Joint Debtor (enter Last, First, Middle): _______________________________ (Check the appropriate box and, if applicable, provide the required information.) 9 Joint Debtor has a Social Security Number and it is: __ __ __ - __ __ - __ __ __ __ (If more than one, state all.) 9 Debtor does not have a Social Security Number.

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

__________________________________________ Signature of Debtor Date

__________________________________________ Signature of Joint Debtor Date

Form 21

2003 COMMITTEE NOTE The form implements Rule 1007(f), which requires a debtor to submit a statement under penalty of perjury setting out the debtor's Social Security number. The form is necessary because Rule 1005 provides that the caption of the petition includes only the final four digits of the debtor's Social Security number. The statement provides the information necessary for the clerk to include the debtor's full Social Security number on the notice of the meeting of creditors, as required under Rule 2002(a)(1). Creditors in a case, along with the trustee and United States trustee or bankruptcy administrator, will receive the full Social Security number on their copy of the notice of the meeting of creditors. The copy of that notice which goes into the court file will show only the last four digits of the number.