Free Local Form LF2083A - PLAN PAYMENT DECLARATION - Washington

Local Form2083A (12/03)

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON

In re: __________________________________________ Debtor(s)

Case Number: ________________________

DEBTOR'S PLAN PAYMENT DECLARATION
1. Plan payments shall be made: Weekly Bi-weekly Semi-monthly Monthly ______________________ Other Payments DATE SOURCE AMOUNT

2.

The first plan payment will be made on or before __________________. (The date specified must be within 30 days after the date the plan is filed.) All subsequent plan payments will be made on or before the _________ day of each subsequent month. (The day specified will be the day when the plan payment is due each month for the remaining term of the plan.) The debtor's employer/ income source is as follows: a. Debtor No. 1 ________________________ Employer I.D. or Last Four Digits of S.S.N.______________ Employer/ Income Source _______________________ Address ____________________________ ___________________________________ ___________________________________ Phone No. ( ) ____________________ Debtor No. 1 is paid: Weekly Bi-weekly Semi-monthly Monthly Other __________________________ Debtor No. 2 ________________________ Employer I.D. or Last Four Digits of S.S.N.______________ Employer/ Income Source ______________________ Address ____________________________ ___________________________________ ___________________________________ Phone No. ( ) _____________________ Debtor No. 2 is paid: Weekly Bi-weekly Semi-monthly Monthly Other __________________________
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3.

4.

b.

c. Deduct payments from wages or income source of: Debtor No. 1 ________ each month Evenly from each check All from one check. If so, pay period from which to deduct is _______________. Other ________________________

Debtor No. 2 ________ each month Evenly from each check All from one check. If so, pay period from which to deduct is _______________. Other ________________________ 5. Debtor acknowledges: a. Immediately after filing, the trustee is authorized to present to the court an order, without notice, directly any entity from whom the debtor receives money, such as employees and governmental agencies, to pay all or part of such income to the Chapter 13 Trustee, except to the extent otherwise subject by law to setoff, recoupment or alternative disposition. Payments made by the debtor directly to the trustee will only be permitted when specifically authorized by an order of the court pursuant to LBR 2083-1 (b). If direct payments are authorized by the court, such payments will be made: 1. In the form of a cashier's check or money order only; (No personal checks or cash will be accepted.) Payable to Daniel H. Brunner, Trustee, and sent to P.O. Box 1003, Memphis, Tennessee 38101-1003; and With the debtor's first and last name and bankruptcy case number, exactly as they appear on the bankruptcy petition, clearly printed on the check.

b.

2.

3.

Dated:

____________________________________ Attorney for Debtor

__________________________________________ Debtor

__________________________________________ Debtor

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