Official Form 103B Application to Have the Chapter 7 Filing Fee Waived

Extracted Text for Proper Search

B132	0 (Form 132	0) (12/1	6) 	 	
U	NITED	 S	TATES	 B	ANKRUPTCY	 C	OURT	 	
_______________ District Of _______________	 	 	
APPLICATION FOR SEARCH OF BANKRUPTCY RECORDS *	 	
 
Name of individual or business that is the subject	 	
of the search:	 	
 	
Social	-Security	 No. or Individual Taxpayer	-Identification 	
No. (ITIN) of Subject:	 	
 
Employer Tax	-Identification No. (EIN) (if any) of Subject:	 	
 	 	 	
Please search your records for the following information regarding the individual or business named above:	 	
□  pending or 	closed bankruptcy cases in this district;	 	
□  pending or closed adversary proceedings;	 	
□  judgments/evidence of satisfaction of judgments; and	 	
□  other [describe briefly]	 	
 
Please search for the period from _____________________________to ___________________	_____________.	 	
 
A fee of $	31.00 is charged for each name or item searched. Payment by check or money order must be enclosed.  Please do 	
not send cash through the mail.	 	
Name, address, and phone number of the person requesting the search:	 	
 
 	
 	
CERTIFICATE 	OF SEARCH	 	
 	
The undersigned clerk hereby certifies the following results of a diligent search of the records of the court:	 	
[Check only the items for which a search was requested and a fee paid.]	 	
 
 	A. Bankruptcy Cases:	 	
 	 	□   None found.	 	
 	 	□   Case filed on  	                                      	  (date).	 	
□  Voluntary 	 	□  Involuntary	 	
 	 	 	□  Pending 	 	□  Closed on 	                                     	 (date).	 	
□  Discharge granted on 	                                                    	 (date).	 	
 	
B. Adversary 	Proceedings:	 	
 	 	□   None found.	 	
 	 	□   Subject is a party to the following proceeding:	 	
 
 	 	                                                               	 (Plaintiff) 	v.                                            	 (Defendant)	 	
 	 	Adversary Proceeding No.	                            	, filed on 	                                          	 (date).	 	
□  Pending 	 	    □  Closed on	                                       	 (date).	 	
Disposition: 	 	□  Dismissed on   	                                                          	        	 (date)	. 	
□  Final Judgment entered on 	                                               	 (date)	. 	
Case Number of Related Bankruptcy Case ______________________	 	
 	
      	                                                  	  Clerk of the Bankruptcy Court	 	  	 	 	 	 	 	 	 	 	 	 	 	
Date: 	                                                 	 	 	By: 	                                                 	   Deputy Clerk	 	
 	
* This form may contain complete social	-security numbers.  It should not be filed electronically.