Arkansas Bankruptcy Filing Fee Installments Form

Applying for a bankruptcy case entails the payment of filing fees ranging from $300.00 to $400.00 (depending on the bankruptcy type). If an individual needs to file for a bankruptcy case but s/he cannot afford the fees, s/he can opt to pay in an installment basis. To avail of this payment method, applicant must fulfill this form and submit it to the court.

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United States Bankruptcy Court	
_______________ District Of ______________	
In re _______________________________________, Case No. ___________________
              Debtor
                                                                                                        	
 Chapter ____________	
APPLICATION TO PAY FILING FEE IN INSTALLMENTS	
1. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the filing fee amounting to
$_____________in installments.
2. I am unable to pay the filing fee except in installments.
3. Until the filing fee is paid in full, I will not make any additional payment or transfer any additional property to an
attorney or any other person for services in connection with this case.
4. The filing fee is to be paid, in accordance with General Or der 32, in full on or before the date first set for the 341(a)
meeting.
5. I understand that if I fail to pay any installment when due, my bankruptcy case may be dismissed and I may not
receive a discharge of my debts.
                                                      	
                                                                       	
Signature of Attorney    Date                                                    Signature of Debtor                     Date        (In a joint case, both spouses must sign.)
                                                      	
                                                                       	
Name of Attorney                                                                     Signature of Joint Debtor (if any) Date
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DECLARATION AND SIGNATURE OF NO N-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)
I declare under penalty of perjury that: (1) I am a bankruptcy pe tition preparer as defined in 11 U.S.C. § 110; (2) I prepared this
document for compensation and have provided the debtor with a  copy of this document and the notices and information required
under 11 U.S.C. §§ 110(b), 110(h), and 342(b); (3) if rules or guide lines have been promulgated pursuant to 11 U.S.C. § 110(h)
setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum
amount before preparing any document for filing for a debtor or  accepting any fee from the debtor, as required under that section;
and (4) I will not accept any additional money or other propert y from the debtor before the filing fee is paid in full.
____________________________________________                __________________________
Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer                      Social Security No. (Required by 11 U.S.C. § 110.)
If the bankruptcy petition preparer is not an individual, state th e name, title (if any), address, and social security number of the
officer, principal, responsible person, or partner who signs the documen\
t.
________________________________
________________________________
Address
x__________________________________________________ _____________________
Signature of Bankruptcy Petition Preparer Date
Names and Social Security numbers of all other individuals who  prepared or assisted in preparing this document, unless the
bankruptcy petition preparer is not an individual:
If more than one person prepared this document, attach additi onal signed sheets conforming to the appropriate Official Form for
each person.  A bankruptcy petition preparer’s failure to comp ly with the provisions of title 11 and the Federal Rules of
Bankruptcy Procedure may result in fines or  imprisonment or both.  11 U.S.C. § 110; 18 U.S.C. § 156.