Attorney/Debtor Name, Address, Phone, Fax, E-mail:
For court use only
UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII Debtor:
and, if any,
Case No. Chapter 13
Joint Debtor: APPLICATION FOR ORDER TO EMPLOYER TO PAY FUNDS TO TRUSTEE ( Amended )
The Debtor/Joint Debtor has a case pending under Chapter 13 of the Bankruptcy Code and agrees to submit wages or other income in the amount below to the supervision and control of the Trustee. The Debtor/Joint Debtor hereby requests that such portion of wages or other income be paid directly to the Trustee by the employer identified below. Dated: ____________________ ________________________________________ Signature of Debtor / Joint Debtor / Attorney ORDER ( IT IS HEREBY ORDERED: Amended )
Debtor Joint Debtor
Name and address of employer of
is directed, until further court order or until notification by the court or the Trustee that this case has been converted to another chapter under the Bankruptcy Code or has been dismissed, to deduct monthly from wages or other income the amount below and to pay such sum, whether monthly, bimonthly, biweekly or weekly, to the Trustee. Amount: $ Howard M.S. Hu, Chapter 13 Trustee 1132 Bishop Street, Suite 301 Honolulu, Hawaii 96813
Payroll deductions for matters such as current income tax withholding, social security, disability, insurance premiums, union dues and mandatory retirement contributions, are not affected by this order and may be continued. Funds sent to the Trustee shall be identified with the Debtor's name and case number. The employer shall notify the Trustee promptly of any change in employment status affecting compliance with this order. Dated: ____________________
hib_1322a1 3/03
_______________________________________ United States Bankruptcy Judge