Application To Pay Filing Fees In Installments By Individual Debtor(S)

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United States Bankruptcy Court
Western District of Washington
Case No. __________
In re
Chapter
________________________,
APPLICATION TO PAY FILING
Debtor
FEES IN INSTALLMENTS BY
INDIVIDUAL DEBTOR(S)
In accordance with Fed. R. Bankr. P. 1006, and Local Rule of Bankruptcy Procedure 1006-1(b), I apply
for permission to pay the balance of my filing fee in installments as set forth below:
A.
Chapter 13: I will pay $100 with the filing of the petition. The balance of my
filing fee, $210, will be paid by the chapter 13 trustee from the monies that I tender to
the trustee as plan payments.
B.
Chapter 7 and Chapter 12: I will pay $100 with the filing of the petition. The
balance of my filing fee, $235 for chapter 7 and $175 for chapter 12, will be paid
under the terms set out in section “D” below.
C.
Individual Chapter 11: I will pay $350 with the filing of the petition. The balance
of my filing fee, $1367, will be paid under the terms set out in section “D” below.
D.
The balance of my filing fee in Chapter 7, 11 or 12 will be paid under these
terms:
$______________ on or before ________________________________
$______________ on or before ________________________________
$______________ on or before ________________________________
Note: No more than three (3) installments payments can be made after the case is
filed and the final installment is due no later than 120 days after the filing of the
petition.
I certify that I am unable to pay the filing fee except in installments. I further certify that I will not
make any additional payment to an attorney or any other person for services in connection with
this case until all filing fees are paid in full. I understand that if I fail to pay my filing fee in
full when due my case may be dismissed and I may not receive a discharge of my debts.
Dated: ________________
Signed:_______________________________________
Debtor
Dated: _________________
Signed:_______________________________________
Joint Debtor (if any)
Application to Pay Filing Fees in Installments
Local Forms W.D. Wash. Bankr., Form 3
Eff. 11/15

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