Payment Advices Cover Sheet

UNITED STATES BANKRUPTCY COURT Western District of Wisconsin PAYMENT ADVICES COVER SHEET in Accordance with 11 U.S.C. Sec. 521(a)(1)(B)(iv) In re: ____________________________________ Debtor(s) Please check the appropriate box. Case No.: ________________ For Debtor: G G G Payment advices (pay stubs) are attached. No payment advices (pay stubs) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). No payment advices (pay stubs) attached for other reason, or some payment advices missing ( please explain). _______________________________________ ________________________________________________________________________ For Joint Debtor, if applicable: G G G Payment advices (pay stubs) are attached. No payment advices (pay stubs) are attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition). No payment advices (pay stubs) attached for other reason, or some payment advices missing ( please explain). _______________________________________ ________________________________________________________________________ I declare under penalty of perjury that I have read this payment advices cover sheet and the attached payment advices, consisting of ______ sheets, numbered 1 through _____, and that they are true and correct to the best of my knowledge, information and belief. Signature of Debtor: _________________________________ Date: ___________ Date: ___________ Signature of Joint Debtor: _________________________________ March 2006 American LegalNet, Inc. www.FormsWorkflow.com Print Save As Reset