Payment Advices Certification

UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH In re: _____________________________ ______________________________ Debtor(s) Case No: ______________ Chapter ____ PAYMENT ADVICES 1 CERTIFICATION Under 11 U.S.C. § 521(a)(1)(B)(iv), I,2 _________________________ hereby state as follows (select one option below): " 1. I have attached hereto, or previously filed with the Court, copies of all payment advices or other evidence of payment received from any employer within 60days before the date of the filing of my bankruptcy petition. I did not receive any payment advices or other evidence of payment at any point during the 60 days before the date of the filing of my bankruptcy petition. I received payment advices from an employer during the 60 days before the date for the filing of my bankruptcy petition but have been unable to locate all of the documents or replacements. I understand that if I do not submit all payment advices or other evidence of payment within 45 days from the filing of my bankruptcy petition, my case will be automatically dismissed without further notice or hearing. " " 2. 3. I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge, information, and belief. Dated this_____day of ______________, 201__. _____________________________________________ (Signature of Debtor) 1 A "Payment Advice" includes, but is not limited to, pay stubs attached to your paycheck, employer's statements of hours and earnings, deposit notifications, etc. 2 A separate form must be submitted by each debtor in a joint case. Rev 12/10 American LegalNet, Inc. www.FormsWorkFlow.com