Form VTB-B 03/2008
UNITED STATES BANKRUPTCY COURT District of Vermont
Payment Advices Cover Sheet
in Accordance with 11 U.S.C. Sec. 521(a)(1)(B)(iv)
In re: Case No. Chapter
Debtor(s) Please Check the Appropriate Box.
For Debtor:
Payment Advices are Attached. Number of Pages Attached: Period Covered (please explain any gaps): Number of Employers From Whom Debtor Received Payment Advices During the 60 Days Prior to Filing the Bankruptcy Petition: No Payment Advices are Attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition. No Payment Advices are Attached for other reason, or some payment advices missing. Please Explain:
For Joint Debtor, if applicable:
Payment Advices are Attached. Number of Pages Attached: Period Covered: Number of Employers From Whom Debtor Received Payment Advices During the 60 Days Prior to Filing the Bankruptcy Petition: No Payment Advices are Attached (the debtor had no income from any employer during the 60 days prior to filing the bankruptcy petition. No Payment Advices are Attached for other reason, or some payment advices missing. Please Explain:
I declare under penalty of perjury that I have read the 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: Signature of Joint Debtor:
Date: Date: