Free BTXN006 - Application to Pay Filing Fee in Installments - Texas

BTXN 006 (4/27/04)

UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF TEXAS § § § § Debtor(s)
APPLICATION TO PAY FILING FEES IN INSTALLMENTS In accordance with Federal Rule of Bankruptcy Procedure 1006(b)(1), an individual may file an Application to Pay Filing Fee in Installments at the time the petition is filed. In accordance with Local Rule 1006.1, an individual who files an application to pay a filing fee in installments without the initial installment payment set forth below, shall be denied. (A) In Chapter 7, 12 and 13 cases, a $50.00 minimum payment is required (B) In a Chapter 11 case, a $100.00 minimum payment is required The balance is to be paid in three (3) payments, due every thirty (30) days from the date the petition was filed. The time period to pay the filing fee is not to exceed one hundred and twenty (120) days. I certify that I am unable to pay the filing fee except in installments. I further certify that I have not paid any money to or transferred any property to an attorney or any other person for services in connection with this case or in connection with any other pending case and that I will neither make any payment nor transfer any property for services in connection with the case until the filing fee is paid in full. I understand that entry of my discharge [or confirmation of any plan] will be delayed until the filing fee is paid in full or, if not paid, that my case will be dismissed without further notice. Dated: Signed:
If this document is prepared by a NON-ATTORNEY BANKRUPTCY PETITION PREPARER, certification printed on page 2 must be completed.

In Re

Case No.

Applicant

Signed: Joint Applicant

DECLARATION BY ATTORNEY CONCERNING PAYMENT OF FILING FEES I have not been paid any money nor accepted any transfer of property as payment for my services and will not do so until the fees have been paid in full. I have made the Applicant(s) aware that the case will be dismissed if the fee is not paid when due. Dated:

Attorney for Debtor(s) Form of payment: Please do not mail cash. Money orders or certified checks only; personal checks of the debtor will not be accepted.

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BTXN 006 (4/27/04)

CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this Application to Pay Filing Fees in Installments. I also certify that I will not accept money or any other property from the debtor before the filing fee is paid in full.

Printed or Typed Name of Bankruptcy Petition Preparer 110(c).)

Social Security No. (Required by 11 U.S.C. §

Firm Name, if any

(Address)

(City, State, ZIP Code)

Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

Signature of Bankruptcy Petition Preparer

Date

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.

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