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form_b2810_0 Appearance of Child Support Creditor or Representative


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B2810 (Form 2810) (12/15)  	
United States  Bankruptcy  Court 	
  	District	 Of	   
In  re  	
Debtor(s)   ,
  Case No.  
I certify under penalty of perjury that I am  a child support creditor* of the above-na med 
debtor, or the authorized representative of s uch child support creditor, with respect to the 
child support obligation which is set out below. 
Na me: 
Telephone Num ber: 
Date	 Child Support  Creditor*  or  Autho rized  Representative  	  	
Summary of  Child  Support  Obligation  	
Am ount  in  arrears:   If Child  Support  has  been  assigned:  
A m ount  currently  due per  week  or  per  m onth:   A
m ount  of  Support  which  is  owed 
under  assign ments:  
on a continuing	 basis:	 	$     	 
$  Am ount  owed  pri mary  child  support  
(per  week)  (per  m onth)   creditor (balance  not assigned):  
Attach  an  itemi zed  statement  of account.  Do  not  disclose  the  name  of  a  minor  child.  See  11 U.S.C.  
ยง  112.  If  a  social  security  num ber  or a  taxpayer  identification  num ber  is included,  set  out  only  the 
last  four  digits  of  the  numbe r. Judicial  Conference  Privacy Policy  (09/01).  
*   Child  support  creditor  includes  both  creditor  to  whom  t h e debtor  has  a  pri mary  obligation  to  pay  child  support 
as  well  as  any  entity  to  whom  such  support  has  been  a ssigned,  if pursuant  to  Se ction  402(a)(26)  of  the  Social 
Security  Act  or  if such  debt  has  been  assigned  to  the  Federal  Govern ment  or  to  any  State  or  political  subdivision 
of  a State.
Next: form_b3130s_0 Order Conditionally Approving Disclosure Statement Previous: form_b2800_0 Disclosure of Compensation of Bankruptcy Petition Preparer
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