Application And Order To Pay Filing Fee In Installments
This is a supplemental form to a Bankruptcy and is to pay the filing fee in installments. The form provided here is simply a sample of what the actual Form B3 looks like.
Form B3 (Official Form 3)
(9/97)
Form 3. APPLICATION AND ORDER TO PAY FILING FEE IN INSTALLMENTS
[Caption as in Form 16B.]
APPLICATION TO PAY FILING FEE IN INSTALLMENTS
1. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the Filing Fee
amounting to $____________________ in installments.
2. I certify that I am unable to pay the Filing Fee except in installments.
3. I further certify that I have not paid any money or transferred any property to an attorney for services in connection with this case and that I will neither make any payment nor transfer any property for services in connection with this case until the filing fee is paid in full.
4. I propose the following terms for the payment of the Filing Fee.*
$ _____________________ Check one
____ With the filing of the petition,
or
____ On or before ________________________
$ _____________________ on or before _________________________________
$ _____________________ on or before _________________________________
$ _____________________ on or before _________________________________
* The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2).
5. I understand that if I fail to pay any installment when due, my bankruptcy case may be dismissed and I may not receive a discharge of my debts.
Signature of Attorney _____________________________________
Date _____________________________________
Signature of Debtor _____________________________________
(In a joint case, both spouses must sign.)
Date _____________________________________
Name of Attorney _____________________________________
Signature of Joint Debtor (if any) _____________________________________
Date _____________________________________
CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION (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 document. 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
_____________________________________
Social Security No. ________________________________
Address _____________________________________
_____________________________________
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.
x__________________________________________________
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.
UNITED STATES BANKRUPTCY COURT
______________________ DISTRICT OF _____________________
In re _______________________________________ Debtor,
Case No. ___________________
Chapter _____________________
ORDER APPROVING PAYMENT OF FILING FEE IN INSTALLMENTS
IT IS ORDERED that the debtor(s) may pay the filing fee in installments on the terms proposed in the foregoing application.
IT IS FURTHER ORDERED that until the filing fee is paid in full the debtor shall not pay any money for services in connection with this case, and the debtor shall not relinquish any property as payment for services in connection with this case.
BY THE COURT
Date: _____________________________________
__________________________________________
United States Bankruptcy Judge