Free Statement of Military Service - California

B202 (8/06)

UNITED STATES BANKRUPTCY COURT ­ EASTERN DISTRICT OF CALIFORNIA

Debtor(s):

Case No.:
(if known)

Chapter:

STATEMENT OF MILITARY SERVICE
The Servicemembers' Civil Relief Act of 2003, Pub. L. No. 108-189, provides for the temporary suspension of certain judicial proceedings or transactions that may adversely affect military servicemembers, their dependents, and others. Parties to a bankruptcy case who might be eligible for relief under the act should complete this form and file it with the Bankruptcy Court. IDENTIFICATION OF SERVICEMEMBER Self (Debtor, Codebtor, Creditor, Other) Non-Filing Spouse of Debtor (name) Other (Name of servicemember) (Relationship of filer to servicemember) (Type of liability) TYPE OF MILITARY SERVICE U.S. Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) or commissioned officer of the Public Health Service or the National Oceanic and Atmospheric Administration (specify type of service): Active Service since: Inductee - ordered to report on: Retired / Discharged: U.S. Military Reserves and National Guard Active Service since: Impending Active Service - Orders postmarked: - Ordered to report on: Retired / Discharged: U.S. Citizen serving with U.S. ally in war or military action (specify ally and war or action): Active Service since: Retired / Discharged: Deployment Servicemember deployed overseas on: Anticipated completion of overseas tour-of-duty: Date

SIGNATURE

_____________________________

Date ________________________

This statement is for information use only. Filing this statement with the Bankruptcy Court does not constitute an application for or invoke the benefits and relief available under the Servicemembers' Civil Relief Act of 2003.