Form 3A
(10/05)
United States Bankruptcy Court
_______________ District Of ______________
In re _______________________________________,
Case No. ___________________
Debtor
Chapter ____________
APPLICATION TO PAY FILING FEE IN INSTALLMENTS
1.
In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the filing fee amounting to $______________ in installments.
2.
I am unable to pay the filing fee except in installments.
3.
Until the filing fee is paid in full, I will not make any additional payment or transfer any additional property to an attorney or any other person
for services in connection with this case.
4.
I propose the following terms for the payment of the Filing Fee.*
$ _____________________
Check one
With the filing of the petition, or
On or before ______________
$ _____________________ on or before ________________________________________
$ _____________________ on or before ________________________________________
$ _____________________ on or before ________________________________________
*
The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the
petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after
filing the petition. Fed. R. Bankr. P. 1006(b)(2).
5.
I understand that if I fail to pay any installment when due, my bankruptcy case may be dismissed and I may not receive a discharge of my debts.
___________________________________________
__________________________________________________________
Signature of Attorney
Date
Signature of Debtor
Date
(In a joint case, both spouses must sign.)
___________________________________________
Name of Attorney
__________________________________________________________
Signature of Joint Debtor (if any)
Date
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