Free UNITED STATES BANKRUPTCY COURT - Florida

UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF FLORIDA REQUEST BY PRO SE DEBTOR TO RECEIVE ELECTRONIC NOTIFICATION
If you are a debtor who filed a bankruptcy case without representation (pro se debtor), and have an internet e-mail address, you may elect to receive electronic notice by e-mail whenever a filing is made with the Court in your case. Separate requests must be completed for each debtor in a joint case (husband and wife). In order to view the documents filed in your case through a hyperlink in the e-mail notice, you must have Adobe Acrobat Reader installed and you must apply for a PACER account by accessing the PACER website: www.pacer.psc.uscourts.gov. The first viewing of the document is free. Additional access to the same document will require you to pay an access fee of $.08 per page, as approved by the Judicial Conference of the United States. You may request to stop electronic notice at any time by completing a Request to Stop Electronic Notification available on our website: www.flmb.uscourts.gov. To sign up for e-mail notification, please provide the information requested below and return this form to the address stated. Name: Case Number: Last four digits of SSN: Address: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Home Telephone Number: Cell Phone Number: Internet E-Mail Address: (Only one permitted) _______________________________________________ _______________________________________________ _______________________________________________

By submitting this request, I consent and agree to the following: All notices required to be sent to me by the Bankruptcy Court will be sent by electronic notification to the above listed internet e-mail address. All notices required to be sent to me by the Bankruptcy Court will not be sent by United States mail. Notice of changes in my internet e-mail address will be immediately provided to the Bankruptcy Court by completing and sending a new request form.

________________________ Date

________________________________________ Signature of Pro Se Debtor

Return the completed form to: United States Bankruptcy Court Middle District of Florida Attn: Christine Baker 135 West Central Boulevard, Suite 950 Orlando, FL 32801

Revised: March, 2009