Plan Payment Declaration {LF2083A}

Local Form 2083A (5/12) UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON In re: Debtor(s) Case Number: DEBTOR'S PLAN PAYMENT DECLARATION 1. The first plan payment will be made on or before . (The date specified must be no later than 30 days after the date of the filing of the plan, or the order for relief, whichever is earlier.) All subsequent plan payments will be made on or before the same day of each subsequent month for the remaining term of the plan. The debtor's employer/income source is as follows: a. Debtor No. 1 Employer I.D. or Last Four Digits of S.S.N. Employer/ Income Source Address Phone No. ( ) Debtor No. 2 Employer I.D. or Last Four Digits of S.S.N. Employer/ Income Source Address Phone No. ( ) 2. b. Debtor No. 1 is paid: Weekly Bi-weekly Semi-monthly Monthly Other Debtor No. 2 is paid: Weekly Bi-weekly Semi-monthly Monthly Other c. Deduct payments from wage or income source of: Debtor No. 1 each month Evenly from each check All from one check. If so, pay period from which to deduct is Other Debtor No. 2 each month Evenly from each check All from one check. If so, pay period from which to deduct is Other Declaration - Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Local Form 2083A (5/12) a. Immediately after filing, the trustee is authorized to present to the court an order, without notice, directing any entity from whom the debtor receives money, such as employers and governmental agencies, to pay all or part of such income to the Chapter 13 Trustee, except to the extent otherwise subject by law or setoff, recoupment or alternative disposition. b. Payments made by the debtor directly to the trustee will only be permitted when specifically authorized by an order of the court pursuant to LBR 2083-1(b). If direct payments are authorized by the court, such payments will be made: 1. 2. 3. In the form of a cashier's check or money order only; (No personal checks, cash or electronic bank transfers (EBT) will be accepted.) Payable to Daniel H. Brunner, Trustee, and sent to P.O. Box 1003, Memphis, Tennessee 38101-1003; and With the debtor's first and last name and bankruptcy case number, exactly as they appear on the bankruptcy petition, clearly printed on the check. Dated: Attorney for Debtor Debtor Debtor Declaration - Page 2 American LegalNet, Inc. www.FormsWorkFlow.com