Free Local Form LF2016A - STATEMENT OF MONEY OR PROPERTY RECEIVED - Washington

Local Form 2016A (9/99)

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON

Case Name: ___________________________

Case Number: _______________________

STATEMENT OF MONEY OR PROPERTY RECEIVED OR PROMISED IN CONNECTION WITH THIS CASE OTHER THAN BY APPLICATION OR A PLAN Name of Applicant: Position of Applicant: Application Number: ____________________________________________ ____________________________________________ _______

No Money or property was received or promised other than by application as a part of a Chapter 13 Plan. (a) Money or things of value received other than by application or as part of a Chapter 13 Plan: (1) (2) Amount received by attorney or firm for filing fee Amount received before the order for relief by attorney or firm for services and costs Amount received after the order for relief by attorney or firm for services and costs Value of any property or service given to attorney or firm as payment of fees and costs Description: Total of entries 1, 2, 3 and 4 Amount remaining in client trust account $____________

$____________

(3)

$____________

(4)

$____________
0.00 $_____________

(5) (6) (b)

$____________
0.00 $____________

Amount applied to filing fee and services (Subtract entry (a)(6) from entry (a)(5))

(c)

(d)

Money promised: Nature of arrangement for promise of payment: ______________________________________________________________ Total amount and value of all money or property received or promised other than by Application or a Chapter 13 Plan (items (a)(5) and (c)) Other Items (Value and description of any liens, guarantees, security interests or promissory notes): _______________________________________________________________ Source of Payment of Promise (If other than the debtor, identify entity and relationship to the debtor): _______________________________________________________________

$_____________

0.00 $_____________

(e)

(f)

STATEMENT OF MONEY OR PROPERTY RECEIVED