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Official Form 101B, Statement About Payment of an Eviction Judgment Against You (individuals)

When you complete the following official bankruptcy form, keep in mind the following: (a) After filing Official Form 101A, Initial Statement About an Eviction Judgment Against You (individuals) (b) After serving on your landlord a copy of Form 101A; (c) You want to stay in your rented residence for 30 days or more after filing Form B101, Voluntary Petition for Individuals Filing for Bankruptcy

 

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meet to serv	e this s	tatement. 
Official Form 101B 	
Statement About Payment of an Eviction Judgment Against You Official Form 101B	
Statement About Paym
ent of an Eviction Judgment Against You 	12/15	
Fill out this form only if: 
you filed	
 Initial Statement About an Eviction Judgment Against You  (Official Form 101A); and
 you served a copy of Form 101A on your landlord; and
 you want to stay in your rented residence for more than 30 days after you file your  Voluntary Petition
for Individuals Filing for Bankruptcy  (Official Form 101).
File this form within 30 days after you file your  Voluntary Petition for Individuals Filing for Bankruptcy (Official Form 101). 
Also serve a copy on your landlord within that same time period. 	
Ce	 rtification About Applicable Law and Payment of Eviction Judgment  
I certify under penalty of perjury that  (Check all that apply ): 	
	Under the state or other nonbankruptcy law that applies to the judgment for possession (eviction
judgment
), I have the right to stay in my residence by paying my landlord the entire delinquent amount
.	
	Within 30 days after I filed my Voluntary Petition for Individuals Filing for Bankruptcy  (Official
Form 10 1), I have paid my landlord the entire amount I owe as stated in the judgmen t for possession
( eviction judgm ent).
	____________________________________________ 		____________________________________________ 	Signature of Debtor 1  Signature of Debtor 2 
Dat	 e	
 _________________ 	Date	 _________________ 	MM /   DD   / YYYY	  	MM /   DD   / YYYY	 	
You must serve your landlord with a copy of this form.
Check the Bankruptcy Rules ( www.uscourts.gov/rulesandpolicies/rules.aspx ) and the court’s local website (go to
http://www.uscourts.gov/Court_Locator.aspx	  to find your court’s website) for any specific requirements that you might have to 	
Debtor 1  __________________________________________________________________   	First Name  Middle Name Last Name	 	
Debtor 2  ________________________________________________________________ (Spouse, if filing)	 First Name  Middle Name Last Name	 	
United States Bankruptcy Court for the:	 __________ 	District of __________	 	
Case number  ___________________________________________ (If known)
  Fill in this information to identify your case:
Next: Official Form, 427 Cover Sheet for Reaffirmation Agreement Previous: Order Waiving Filing Fees
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