IN THE MAGISTRATE COURT OF
COUNTY, WEST VIRGINIA
Plaintiff v. Case No.
Defendant
AFFIDAVIT: NOTICE OF FILING OF BANKRUPTCY PETITION
STATE OF WEST VIRGINIA COUNTY OF , TO-WIT,
This day and on his o her oath or affirmation says: 1. 2. I am the judgment debtor in the above-styled action. That on clerk of a United States Bankruptcy Court.
appeared before me,
(date), I filed a bankruptcy petition with the
WHEREFORE, I request this Court to render a stay of execution pending further proceedings in the United States Bankruptcy Court.
Judgment Debtor s Signature
Taken, subscribed and sworn or affirmed before me this My commission expires on
day of
Notary Public/Magistrate Assistant/Magistrate Clerk
11 U.S.C. § 362 SCA-M662NP / 2-00
Judgment Debtor File