Fill and Sign the Official Bankruptcy Forms Moses Apsan

B 281 (12/94)United States Bankruptcy Court _______________ District Of ________________ In re _______________________________ Case No. _____________ Debtor Chapter __________ APPEARANCE OF CHILD SUPPORT CREDITOR* OR REPRESENTATIVE I certify under penalty of perjury that I am a child support creditor* of the above-named debtor, or the authorized representative of such ch ild support cred itor, with respect to the c hild suppo rt obligation wh ich is set out below . Name: Organization: Address: Teleph one N umber: __________________________ X ____________________________________________________ Da te Child Su pport C reditor* or Auth orized R epresentative Summary of Child Support Obligation Am oun t in arrea rs: If Ch ild Suppo rt has b een a ssign ed: $ ___________________________ Amount of Support which is owed under assignments: Amount currently due per week or per month: $ _______________________on a continuing basis: Amount ow ed primary child su pport $ ____ _____ _____ _____ _____ ___ creditor (balance not assigned ): (per week) (per month) $ _______________________ Attach an itemized statement of account * Child support creditor includes both creditor to whom the debtor has a primary obligation to pay child support as well as any entity to whom such support has been assigned, if pursuant to Section 402(a)(26) of the Social Security Act or if such debt has been assigned to the Federal Government or to any State or political subdivision of a S tate.