Bowling Green Municipal Court Form
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2BOWLING GREEN MUNICIPAL COURT
711 S. Dunbridge Rd., P.O. Box 326
Bowling Green, OH 43402-0326
(419) 352-5263
In Re:
__________________________________________
Debtor
__________________________________________
Address
__________________________________________
City/State/Zip
No. ______________________________
Tel. Hm. _______________ Wk. _______________
STATEMENT AS TO CREDITORS
Employer __________________________________
Pay Period: ________________________
STATE OF OHIO, WOOD COUNTY, SS:
The following is a full, accurate, and complete statement of the names of the unsecured creditors of the
undersigned, their addresses, and amount due and owing to each:
NAME
ADDRESS
ACCT #
AMOUNT
DUE
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