Form F 8002-1 - Application For Waiver Of The Appellate Filing Fee In A Chapter 7 Case Page 3
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1
2
3Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Other assets?
Describe the other assets:
15.
Current value:
$_________________
Do not include household items
$_________________
Amount you owe
and clothing.
on liens:
Money or property due you?
Who owes you the money or property?
How much is owed?
Do you believe you will likely receive
16.
payment in the next 180 days?
Examples: Tax refunds, past due
___________________________________________
$_________________
No
or lump sum alimony, spousal
support, child support,
$_________________
___________________________________________
Yes. Explain:
maintenance, divorce or property
settlements, Social Security
benefits, workers’ compensation,
personal injury recovery
Part 4:
Answer These Additional Questions
Have you paid anyone for
17.
No
services for this case, including
How much did you pay?
Yes. Whom did you pay? Check all that apply:
filling out this application, the
bankruptcy filing package, or the
An attorney
$______________________
schedules?
A bankruptcy petition preparer, paralegal, or typing service
Someone else
________________________________________
Have you promised to pay or do
18.
No
you expect to pay someone for
Yes. Whom do you expect to pay? Check all that apply:
How much do you
services for your bankruptcy
expect to pay?
case?
An attorney
A bankruptcy petition preparer, paralegal, or typing service
$_______________________
Someone else
_________________________________________
Has anyone paid someone on
19.
No
your behalf for services for this
Yes. Who was paid on your behalf?
Who paid?
How much did
case?
Check all that apply:
Check all that apply:
someone else pay?
An attorney
Parent
$______________________
Brother or sister
A bankruptcy petition preparer,
Friend
paralegal, or typing service
Pastor or clergy
Someone else
_________________
Someone else
__________
Have you filed for bankruptcy
20.
No
within the last 8 years?
Yes.
District _____________________________ When _____________ Case number _____________________
MM/ DD/ YYYY
District _____________________________ When _____________ Case number _____________________
MM/ DD/ YYYY
District _____________________________ When _____________ Case number _____________________
MM/ DD/ YYYY
Part 5:
Sign Below
By signing here under penalty of perjury, I declare that I cannot afford to pay the filing fee either in full or in installments. I also declare
that the information I provided in this application is true and correct.
_____________________________________________
_____________________________________________
Signature of Debtor 1
Signature of Debtor 2
Date __________________
Date __________________
_______________________________________________________
MM / DD / YYYY
MM / DD / YYYY
This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central Distict of California.
F 8002-1.APPEAL.FEE.WAIVER.APP
June 2016
Page 3
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