Home | U.S. Bankruptcy Court Middle District of Florida
UNITED STATES BANKRUPTCY COURT
MIDDLE DISTRICT OF FLORIDA
TAMPA DIVISION
flmb.
In re: Case No.: 8:xx-bk-xxxxx-CPM
Chapter: 11 [alternatively, if applicable,
Small Business Chapter 11 Case]
Debtor
Joint Debtor
Debtors.
_____________________________/
DECLARATION OF PAYMENT OF QUARTERLY FEES
FOR CALENDAR YEAR _______
CALENDAR QUARTER ENDING (CHECK ONE)
MARCH 31___JUNE 30___SEPTEMBER 30___DECEMBER 31___OTHER___FINAL___
Total Disbursements for Quarter[1] $__________________________
Quarterly Fees Owed Pursuant to 28 U.S.C. § 1930(a)(6) $__________________________
Quarterly Fees Paid (Attach proof of payment) $__________________________
Date of Payment ___________________________
In accordance with 28 U.S.C. § 1746, I declare under penalty of perjury and under the laws of the United States that I have read and certify that the figures, statements, disbursements, itemizations, and payments as stated above are true and correct.
Executed on:_____________________
_____________________________Signature
Debtor In Possession [trustee]
__________________________Printed Name
___________________________Address
___________________________
___________________________Phone
-----------------------
[1] Total Disbursements for Quarter should total the same as disbursements indicated on the filed financial monthly operating reports or post-confirmation quarterly reports filed in the case respective to the applicable quarterly fee assessment period.
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