CACB — Application for Waiver of the Appellate Filing Fee in a (F8002-1APPEALFEEWAIVERAPP)

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/F8002-1APPEALFEEWAIVERAPP.pdf

Fill in this information to identify your case:

Debtor 1 ________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name

United States Bankruptcy Court for the Central District of California Case number ___________________________________________ Check if this is an (If known) amended filing

Application for Waiver of the Appellate Filing Fee in a Chapter 7 Case

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known).

Part 1: Tell the Court About Your Family and Your Family’s Income

1. What is the size of your family? Check all that apply: Your family includes you, your spouse, and any dependents listed You on Schedule J: Your Expenses Your spouse (Official Form 106J). Your dependents ___________________ _____________________ How many dependents? Total number of people

2. Fill in your family’s average monthly income. That person’s average monthly net income

Include your spouse’s income if (take-home pay)
your spouse is living with you, even Add your income and your spouse’s income. Include the
if your spouse is not filing. value (if known) of any non-cash governmental assistance You .................. $_________________
that you receive, such as food stamps (benefits under the

Do not include your spouse’s Supplemental Nutrition Assistance Program) or housing income if you are separated and subsidies. your spouse is not filing with you. If you have already filled out Schedule I: Your Income, see Your spouse .... + $_________________ line 10 of that schedule.

Subtotal ............. $_________________

Subtract any non-cash governmental assistance that you $_________________ included above. –

Your family’s average monthly net income Total .................. $_________________

Type of assistance

3. Do you receive non-cash No governmental assistance? Yes. Describe. ...........

4. Do you expect your family’s No average monthly net income to Yes. Explain. ............. increase or decrease by more than 10% during the next 6 months?

5. Tell the court why you are unable to pay the filing fee in installments within 120 days. If you have some additional circumstances that cause you to not be able to pay your filing fee in installments, explain them.

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This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central Distict of California.

June 2016 Page 1 F 8002-1.APPEAL.FEE.WAIVER.APP

Debtor 1 _______________________________________________________ Case number (if known) _____________________________________ First Name Middle Name Last Name

Part 2: Tell the Court About Your Monthly Expenses

6. Estimate your average monthly expenses. Include amounts paid by any government assistance that you $___________________ reported on line 2.

   If you have already filled out Schedule J, Your Expenses, copy line 22 from that form.

7. Do these expenses cover anyone No who is not included in your family Yes. Identify who ........ as reported in line 1?

8. Does anyone other than you No regularly pay any of these expenses? Yes. How much do you regularly receive as contributions? $_________ monthly If you have already filled out Schedule I: Your Income, copy the total from line 11.

9. Do you expect your average No monthly expenses to increase or Yes. Explain ................ decrease by more than 10% during the next 6 months?

Part 3: Tell the Court About Your Property

If you have already filled out Schedule A/B: Property (Official Form 106A/B) attach copies to this application and go to Part 4.

10. How much cash do you have? Examples: Money you have in your wallet, in your home, and on Cash: $_________________ hand when you file this application

11. Bank accounts and other deposits Institution name: Amount: of money? Examples: Checking, savings, Checking account: __________________________________________________ $__________________ money market, or other financial accounts; certificates of deposit; Savings account: __________________________________________________ $__________________ shares in banks, credit unions, brokerage houses, and other Other financial accounts: __________________________________________________ $__________________ similar institutions. If you have more than one account with the Other financial accounts: __________________________________________________ $__________________ same institution, list each. Do not

include 401(k) and IRA accounts.

12. Your home? (if you own it outright or _______________________________________________________ are purchasing it) Number Street Current value: $_________________

Examples: House, condominium, _______________________________________________________ Amount you owe manufactured home, or mobile home City State ZIP Code on mortgage and $_________________ liens:

13. Other real estate? _______________________________________________________ Current value: $_________________ Number Street Amount you owe _______________________________________________________ on mortgage and $_________________ City State ZIP Code liens:

14. The vehicles you own? Make: _____________________ Current value: $_________________ Examples: Cars, vans, trucks, Model: _____________________

sports utility vehicles, motorcycles, Year: ____________ Amount you owe
tractors, boats on liens: $_________________
Mileage _____________________

Make: _____________________
Model: _____________________ Current value: $_________________

Year: ____________ Amount you owe
Mileage _____________________ on liens: $_________________

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This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central Distict of California.

June 2016 Page 2 F 8002-1.APPEAL.FEE.WAIVER.APP

Debtor 1 _______________________________________________________ Case number (if known) _____________________________________ First Name Middle Name Last Name

15. Other assets? Describe the other assets: Current value: $_________________

Do not include household items $_________________ and clothing. Amount you owe on liens:

16. Money or property due you? Who owes you the money or property? How much is owed? Do you believe you will likely receive payment in the next 180 days?

Examples: Tax refunds, past due
or lump sum alimony, spousal ___________________________________________ $_________________ No
support, child support, ___________________________________________ $_________________ Yes. Explain: maintenance, divorce or property
settlements, Social Security
benefits, workers’ compensation,
personal injury recovery

Part 4: Answer These Additional Questions

17. Have you paid anyone for No services for this case, including Yes. Whom did you pay? Check all that apply: How much did you pay? filling out this application, the bankruptcy filing package, or the An attorney schedules? $______________________ A bankruptcy petition preparer, paralegal, or typing service Someone else ________________________________________

18. Have you promised to pay or do No you expect to pay someone for Yes. Whom do you expect to pay? Check all that apply: services for your bankruptcy How much do you case? An attorney expect to pay? A bankruptcy petition preparer, paralegal, or typing service $_______________________ Someone else _________________________________________

19. Has anyone paid someone on 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 $______________________ A bankruptcy petition preparer, Brother or sister paralegal, or typing service Friend Pastor or clergy Someone else _________________ Someone else __________

20. Have you filed for bankruptcy 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.

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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. June 2016 Page 3 F 8002-1.APPEAL.FEE.WAIVER.APP