UNITED STATES BANKRUPTCY COURT DISTRICT OF SOUTH DAKOTA In re: R.E. FORM, Debtor. ) ) ) ) ) Bankr. Case No. 05-10175 Chapter 7 EMPLOYEE INCOME RECORDS
Pursuant to 11 U.S.C. ยง 521(a)(1)(B)(iv), I certify the attached copies are true and correct copies of all payment advices or other evidence of payment I received from any employer within 60 days before the date of the filing of my petition.
Dated: October 17, 2005
_________________________ R.E. Form