Free Change of Address - North Carolina

LOCAL FORM 12 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NORTH CAROLINA In re: ) ) ) ) ) ) Case No. Chapter

DECEMBER 2007

Debtor(s)

NOTICE OF CASE SPECIFIC NAME AND/OR ADDRESS CHANGE PURSUANT TO 11 U.S.C. § 342(e) AND LOCAL RULES 2002-1 and 3001-1 Pursuant to 11 U.S.C § 342(e) and Local Rules 2002-1 and 3001-1, (creditors name) files this notice of address to be used to provide notice in the above-captioned case. (Creditors name) is aware that, pursuant to 11 U.S.C. § 342(e)(2), any notice in this case required to be provided to the creditor by the debtor or the court will not be provided to the address designated herein until after five (5) days following receipt of this notice of address change by the court and the debtor(s). Current creditor name and address: Name: Address 1: Address 2: Address 3: Address 4: City, State, Zip Revised creditor name and address: [ [ [ Name: Address 1: Address 2: Address 3: Address 4: City, State, Zip ] for payment purposes only ] for notice purposes only ] for both payment and notice purposes

Authorization: Under penalty of perjury, I, the undersigned, affirm that I am authorized to request this address change. Name and position: Signature: Date: (Print or Type)

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