Free Debtor's Application for Waiver of the Chapter 7 Filing Fee or Other Fee - California

Official Form 3B

12/2007

DEBTOR'S APPLICATION FOR WAIVER OF THE CHAPTER 7 FILING FEE OR OTHER FEE

The court fee for filing a case under chapter 7 of the Bankruptcy Code is $299. If you cannot afford to pay the full fee at the time of filing, you may apply to pay the fee in installments. A form, which is available from the bankruptcy clerk's office, must be completed to make that application. If your application to pay in installments is approved, you will be permitted to file your petition, completing payment of the fee over the course of four to six months. If you cannot afford to pay the fee either in full at the time of filing or in installments, then you may request a waiver of the filing fee by completing this application and filing it with the Clerk of Court. A judge will decide whether you have to pay the fee. By law, the judge may waive the fee only if your income is less than 150 percent of the official poverty line applicable to your family size and you are unable to pay the fee in installments. You may obtain information about the poverty guidelines at www.uscourts.gov or in the bankruptcy clerk's office. Required information. Complete all items in the application, and attach requested schedules. Then sign the application on the last page. If you and your spouse are filing a joint bankruptcy petition, you both must provide information as requested and sign the application.

Official Form 3B

UNITED STATES BANKRUPTCY COURT ­ EASTERN DISTRICT OF CALIFORNIA

12/2007

Name of Debtor(s):

Case No. (If known):

DEBTOR'S APPLICATION FOR WAIVER OF THE CHAPTER 7 FILING FEE OR OTHER FEE
I / We hereby apply for waiver of:

G G

the Chapter 7 filing fee or other fee (specify)

Part A. Family Size and Income
1. Including yourself, your spouse, and dependents you have listed or will list on Schedule I, Current Income of Individual Debtor(s), how many people are in your family? (Do not include your spouse if you are separated AND are not filing a joint petition.) 2. Restate the following information that you provided, or will provide, on Line 16 of Schedule I. Attach a completed copy of Schedule I, if it is available. Total Combined Monthly Income (Line 16 of Schedule I) 3. State the monthly net income, if any, of dependents included in Question 1 above. Do not include any income already reported in Question 2. If none, enter $ 0. 4. Add the "Total Combined MonthlyIincome" reported in Question 2 to your dependents* monthly net income from Question 3. $ $ $

5. Do you expect the amount in Question 4 to increase or decrease by more than 10% during the next 6 months? If yes, explain.

G No

G Yes

Part B. Monthly Expenses
6. EITHER (a) attach a completed copy of Schedule J, Schedule of Monthly Expenses, and state your total monthly expenses reported on Line 18 of that Schedule, OR (b) if you have not yet completed Schedule J, provide an estimate of your total monthly expenses.

$

7. Do you expect the amount in Question 6 to increase or decrease by more than 10% during the next 6 months? If yes, explain.

G No

G Yes

Part C. Real and Personal Property
EITHER (I) attach completed copies of Schedules A, Real Property, and Schedule B, Personal Property, OR (2) if you have not yet completed those schedules, answer the following questions. 8. State the amount of cash you have on hand. $

9. State below any money you have in savings, checking, or other accounts in a bank or other financial institution. Type of Account (savings, checking, CD) $ $ $ $

Bank or Other Financial Institution

Amount

10. State below the assets owned by you. Do not list ordinary household furnishings and clothing. Home Address: Value: Amount owed in mortgages and liens: $ Amount owed in mortgages and liens: $ Amount owed: $ Amount owed: $ Amount owed: $

$ Other real estate Address: Value:

$ Motor vehicle Model/Year: Value: $ Motor vehicle Model/Year: Value: $ Other Description Value: $

11. State below any person, business, organization, or governmental unit that owes you money and the amount that is owed. Name of Person, Business, or Organization that Owes You Money $ $ $ Amount Owed

Part D. Additional Information
12. Have you paid, promised to pay, or do you anticipate paying an attorney or anyone other than an attorney (such as a bankruptcy petition preparer, paralegal, typing service, or another person) any money for services in connection with this case, including the completion of this form, the bankruptcy petition, or schedules?

G No G Yes. State below the name, address, and amount(s) you have paid, promised to pay, and/or anticipate paying each attorney or other person or entity for services in connection with this case. Attach additional sheets if more than two.
Title (if other than attorney) Amount you have promised to pay or anticipate paying

Name and Address

Amount Paid

$

$

$

$

13. Has anyone paid an attorney or other person or service in connection with this case, on your behalf? If yes, explain.

G No

G Yes

14. Have you previously filed for bankruptcy relief during the past eight years? Case Number (if known) Year filed Location of filing

G No

G Yes

Did you obtain a discharge? (If known)

G Yes G Yes

G No G No

G Don't know G Don't know

15. Please provide any other information that helps to explain why you are unable to pay the filing fee in installments.

16. I(we) declare under penalty of perjury that I(we) cannot currently afford to pay the filing fee in full or in installments and that the foregoing information is true and correct.

Executed on:

____________________ Date

Signature of Debtor

____________________ Date

Signature of Joint Debtor (if any)

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required in that section.

___________________________________________________ Printed or Typed Name of Bankruptcy Petition Preparer

____________________________________________________ Social Security No. (Required under 11 U.S.C. § 110.)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person or partner who signs this document. ___________________________________________________ ___________________________________________________ Address X__________________________________________________ Signature of Bankruptcy Petition Preparer ____________________________ Date

Names and Social Security Numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition preparer is not an individual: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.