Individual Debtor'S Application To Pay Filing Fees In Installments Form
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1UNITED STATES BANKRUPTCY COURT
DISTRICT OF OREGON
In re
)
) Case No. _________________
)
) INDIVIDUAL DEBTOR'S
) APPLICATION TO PAY FILING
Debtor(s)
) FEES IN INSTALLMENTS
In accordance with Fed. Bankruptcy Rule 1006, application is made for permission to pay all the fees for filing on
the following terms:
a. If a CHAPTER 7 CASE - $________ with the filing of the petition and the balance as follows:
$_________ (at least $50) within 30 days,
$_________ (at least $50) within 60 days, and
$_________ (the balance of the fee) within 90 days from the entry date of the order allowing installment
payments.
b. If a CHAPTER 11 CASE - $________ (at least $405) with the filing of the petition and the balance as
follows: $________ within 30 days and $________ within 60 days from the entry date of the order
allowing installment payments.
c. If a CHAPTER 12 CASE - $________ with the filing of the petition and the balance of $________ within
45 days from the entry date of the order allowing installment payments.
d. If a CHAPTER 13 CASE - $_________ (at least $185) with the filing of the petition and the balance of
$_________ within 45 days from the entry date of the order allowing installment payments.
I certify that I am unable to pay all the filing fees 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 MY CASE MAY BE PROMPTLY DISMISSED, AND I MAY NOT RECEIVE A DISCHARGE OF
MY DEBTS, IF I FAIL TO PAY ANY AMOUNT ON TIME.
Dated: ____________
Signed: __________________________________________
Applicant
Signed: ___________________________________________
Applicant
Email Reminder: If you would like to receive an email reminder from the court regarding your payments, please
complete this information:
Debtor’s email address: ________________________________________________________________________
(If applicable) Joint debtor’s email address: ________________________________________________________
Note: You will receive an Order to Pay in Installments in the mail that lists each payment and when it is due. The
Court will also attempt to send an email reminder, but whether or not you receive the reminder, you are responsible
for making each payment on or before the due date. The Court cannot confirm an email address is accurate and
will not resend an email that is undeliverable.
110 (12/1/13)
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