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Fill and Sign the Lf 2083a 101 Form

Fill and Sign the Lf 2083a 101 Form

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D ecla ra tio n – P ag e 1 LF 2083A (1/01) UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON In re: C ase No. Debtor(s). DEBTOR'S PLAN PAYMENT DECLARATION 1. Plan payments shall be made:  Weekly  Bi-weekly  Semi-monthly  Monthly  __________________  Other Payments DATE SOURCE AMOUNT 2. The first plan payment will be made on or before ,20 . (The date specified must be within 30 days after the date the plan is filed.) 3. All subsequent plan payments will be made on or before the day of each subsequent month. (The day specified will be the day when the plan payment is due each month for the remaining term of the plan.) 4. The debtor’s employer/income source is as follows: a. Debtor No. 1____________________________ Debtor No. 2____________________________ Employee I.D. or S.S.N.___________________ Employee I.D. or S.S.N.___________________ Employer/ Employer/ Income Source__________________________ Income Source__________________________ Address________________________________ Address________________________________ _______________________________________ ______________________________________ _______________________________________ _______________________________________ Phone No. ( )__________________________ Phone No. ( )_________________________ b. Debtor No. 1 is paid: Debtor No. 2 is paid:  Weekly  Weekly  Bi-weekly  Bi-weekly  Semi-monthly  Semi-monthly  Monthly  Monthly KLSAFKLAS __________________________________________________________________________________________________ Declaration - Page 2  Other  Other c. Deduct payments from wages or income source of:  Debtor No. 1 each month  Evenly from each check  All from one check. If so, pay period from which to deduct is .  Other .  Debtor No. 2 each month  Evenly from each check  All from one check. If so, pay period from which to deduct is .  Other ___________________________ 5. Debtor acknowledges: a. Immediately after filing, the trustee is authorized to present to the court an order, without notice, directing any entity from whom the debtor receives money, such as employers and governmental agencies, to pay all or part of such income to the Chapter 13 Trustee, except to the extent otherwise subject by law to setoff, recoupment or alternative disposition. b. Payments made by the debtor directly to the trustee will only be permitted when specifically authorized by an order of the court pursuant to LBR 2083-1(b). If direct payments are authorized by the court, such payment will be made: 1. In the form of a cashier's check or money order only; (No personal checks or cash will be accepted.) 2. Payable to Daniel H. Brunner, Trustee, and sent to P. O. Box 1003, Memphis, Tennessee, 38101-1003; and 3. With the debtor’s first and last name and bankruptcy case number, exactly as they appear on the bankruptcy petition, clearly printed on the check. Dated: ______________________________________________ _______________________________________ Attorney for Debtor Debtor __________________________________________________________________________________________________ Declaration - Page 3 _______________________________________ Debtor

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