Fill and Sign the Bankruptcy Information Sheetustdepartment of Justice

CHAPTER 13 TRUSTEE INFORMATION SHEET The Debtor(s) are required to complete and file this information sheet with the Chapter 13 Trustee within 15 days of the filing of the Chapter 13 Case. LBR CASE# DEBTOR 1 DEBTOR 2 NAME: NAME: [ ] Address is the same as Debtor 1 HOME ADDRESS: HOME ADDRESS: ADDRESS: ADDRESS: HOME PHONE: HOME PHONE: Employer addresses and phone numbers. Issue Wage Deduction on Debtor 1 or 2 (please check). DEBTOR 1 [ ] DEBTOR 2 [ ] EMPLOYER NAME: EMPLOYER NAME: ADDRESS: ADDRESS: ADDRESS: ADDRESS: PHONE: ( ) PHONE: ( ) PAID: WEEKLY [ ] BIWEEKLY [ ] MONTHLY [ ] PAID: WEEKLY [ ] BIWEEKLY [ ] MONTHLY [ ] SEMI-MONTHLY [ ] OTHER SEMI-MONTHLY [ ] OTHER DEBTOR 1 OTHER SOURCES OF INCOME: DEBTOR 2 OTHER SOURCES OF INCOME: The debtor(s) and their attorney, if any, certifies that attached hereto are the two most recent pay stubs or other income verification for each debtor. All required tax returns have been filed. YES [ ] NO [ ] If no, the following years are unfiled: Tax refunds received for the last 2 years: YR $ YR $ Date Debtor's attorney Pro Se Debtor Pro Se Debtor [Local Bankruptcy Form 13-2 ]