Free Declaration of Evidence of Payments Form - Arizona


File Size: 10.0 kB
Pages: 1
Date: September 12, 2006
File Format: PDF
State: Arizona
Category: Bankruptcy
Author: mtemple
Word Count: 154 Words, 1,067 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.azb.uscourts.gov/Documents/Declaration_of_Evidence_of_Payments_Form.pdf

Download Declaration of Evidence of Payments Form ( 10.0 kB)


Preview Declaration of Evidence of Payments Form
UNITED STATES BANKRUPTCY COURT DISTRICT OF ARIZONA

In re

) ) ) ) ) _________________________Debtor(s)___)

Chapter _____ Case No._______________

Declaration of Evidence of Employers' Payments Within 60 Days

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Attached hereto are copies of all payment advices, pay stubs or other evidence of payment received by the debtor from any employer within 60 days prior to the filing of the petition; Debtor has received no payment advices, pay stubs or other evidence of payment from any employer within 60 days prior to the filing of the petition; or Debtor has received the following payments from employers within 60 days prior to the filing of the petition: $__________. Debtor declares the foregoing to be true and correct under penalty of perjury.

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Dated:________________

____________________________ Signature of Debtor

If attaching pay stubs or other payment advices, it is your responsibility to redact (black out) any social security numbers, names of minor children, dates of birth or financial account numbers before attaching them to this document.