Form 13 Application and Order for Waiver of Miscellaneous Fees
[Caption: Official Form 16A]
Application for Waiver of
Miscellaneous Administrative Fee[1]
1. The debtors filed a voluntary chapter [number] bankruptcy petition contemporaneously with this application.
2. The debtors believe they are entitled to relief under chapter [number].
3. The debtors are indigent and are unable to pay the miscellaneous administrative fee or give security therefor.
4. The debtors’ income consists of $[amount].
5. The debtors have [number] children dependent upon them for support.
6. The debtors’ basic monthly expenses exceed their income.
7. The debtors do not have any stocks, bonds, bank accounts, or other liquid assets from which they can pay the miscellaneous administrative fee.
8. The debtors own no real estate other than their residence, in which they have no equity and which is subject to foreclosure.
9. The debtors do not own an automobile or any item of household furnishings worth more than $200.
10. There are no family or friends who could provide funds to the debtors for payment of the miscellaneous administrative fee.
11. The debtors’ rights under Title 11 will be prejudiced if the debtors’ petition and schedules are not accepted for filing or if their bankruptcy is dismissed for failure to pay the miscellaneous administrative fee.
WHEREFORE, the debtors request that this Court waive payment of the miscellaneous administrative fee and permit them to proceed with their bankruptcy without payment of the fee or security therefor.
[signature]
Attorney for Debtors
Verification
I, [debtor], verify under penalty of perjury that the foregoing is true and correct.
[signature]
Debtor
Executed on: [date]
[Caption: Official Form 16B]
Order to Waive Miscellaneous Administrative Fee
AND NOW, this [date] day of [month], [year], upon consideration of the debtors’ application to waive the miscellaneous administrative fee for the filing of their bankruptcy petition, it is hereby ordered that the fee is waived and the debtors are permitted to proceed with their bankruptcy without payment of the miscellaneous administrative fee.
Date: [signature]
United States Bankruptcy Judge
[1] A debtor whose income is below 150 percent of the poverty line and who is unable to pay the filing fee in installments may seek a complete chapter 7 filing fee waiver under 28 U.S.C. § 1930(f). To do so the debtor should file an Application on Official Form 3B. See Chs. 5, 6; Appx. B, supra. The form provided here may be used if the debtor is not eligible for a chapter 7 fee waiver to obtain a waiver of the $46 miscellaneous administrative fee normally payable upon the filing of a chapter 7 or chapter 13 case. The form can be modified to also seek waiver of the $15 trustee surcharge applicable in chapter 7 cases. These fee waivers should be available pursuant to 28 U.S.C. § 1915. See Ch. 5, supra. Different courts may also have varying requirements regarding the specificity of the statement of the debtor’s financial situation.