Debtors Statement Of Domestic Support Obligation(s) (Debtor And Joint Debtor)

Penalty for making a false statement: Fine up to $250,000 or imprisonment for up to 5 years or both. 18 U.S.C. 247247 152 and 3571UNITED STATES BANKRUPTCY COURTDISTRICT OF IDAHOIn re,Debtor(s).Case Number: Chapter: DEBTOR222S STATEMENT OF DOMESTIC SUPPORT OBLIGATION(S)If filing jointly, information for joint debtor must be filled out on a separate form. Debtor222s name (enter full name): Does Debtor have a domestic support obligation: yes no. If yes, please fill out the rest of this form. Ifno, do not fill out the rest, but sign where indicated below.Debtor222s employer222s name, address, and phone number: .Name, address and phone number for the holder of the claim of support:.AS OF THE DATE OF FILING THE BANKRUPTCY PETITION:Amount of support obligation: $ per (i.e. month, week, etc.)Term of support obligation: from until .Amount that the domestic support obligation is in arrears: $.Court name and jurisdiction in which order of support was issued:.Court Case No. .Name, address and phone number of the State child support enforcement agency involved in such claim:. I declare under penalty of perjury that the foregoing is true and correct.Signature of DebtorDate American LegalNet, Inc. www.FormsWorkFlow.com Penalty for making a false statement: Fine up to $250,000 or imprisonment for up to 5 years or both. 18 U.S.C. 247247 152 and 3571UNITED STATES BANKRUPTCY COURTDISTRICT OF IDAHOIn re,Debtor(s).Case Number: Chapter: JOINT DEBTOR222S STATEMENT OF DOMESTIC SUPPORT OBLIGATION(S)If filing jointly, information for joint debtor must be filled out on this form. Joint Debtor222s name (enter full name): Does Joint Debtor have a domestic support obligation: yes no. If yes, please fill out the rest of thisform. If no, do not fill out the rest, but sign where indicated below.Joint Debtor222s employer222s name, address and phone number: .Name, address and phone number for the holder of the claim of support:.AS OF THE DATE OF FILING THE BANKRUPTCY PETITION:Amount of support obligation: $ per (i.e. month, week, etc.)Term of support obligation: from until .Amount that the domestic support obligation is in arrears: $.Court name and jurisdiction in which order of support was issued:.Court Case No. .Name, address and phone number of the State child support enforcement agency involved in such claim:. I declare under penalty of perjury that the foregoing is true and correct.Signature of Joint DebtorDate American LegalNet, Inc. www.FormsWorkFlow.com