UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF MISSOURI

In re:	Case No. ______________

, Debtor	Chapter ______________

APPLICATION TO PAY FILING FEES IN INSTALLMENTS

In accordance with Federal Rule of Bankruptcy Procedure 1006, I/we apply for permission to pay the Filing Fee of

$ _______ in installments, and certify that I/we cannot pay the Filing Fee except in installments. Until the Filing Fee is paid in full, I will not make any additional payments or transfer any additional property to an attorney or any other person for services in connection with this case. I/We will make the following payments to pay the Filing Fee in full.

The following two payments must equal 50% of the filing fee.

$____________________ with the filing of the petition (voluntary amount)

$____________________ on or before 7 days after the filing date of the petition

The remaining balance of the filing fee will be paid as follows:

$____________________ on or before 60 days after the filing date of the petition

$____________________ on or before 90 days after the filing date of the petition

I understand that if I/we do not make any payment when it is due, my/our bankruptcy case will be dismissed without further notice or hearing, unless otherwise ordered by the Court. I/We understand that my/our debts will not be discharged until the entire filing fee is paid, and that my/our rights in other bankruptcy proceedings may be affected.

Signature of Attorney (L.R. 9011)	Date	Signature of Debtor	Date

(In a joint case, both spouses must sign)

Name of Attorney	Signature of Joint Debtor (if any)	Date

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)

I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required under that section; and (4) I will not accept any additional money or other property from the debtor before the filing fee is paid in full.

Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer	Social Security Number (Required by 11 U.S.C. § 110)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person, or partner who signs the document.

_______________________________________________

ADDRESS

X __________________________________________________	____________________________

Signature of Bankruptcy Petition Preparer	Date

Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer is not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.

CERTIFICATE OF SERVICE

I certify that a true and correct copy of the foregoing document was filed electronically on the ___day of _______ 20__, with the United States Bankruptcy Court, and has been served on the parties in interest via e-mail by the Court's CM/ECF System as listed on the Court's Electronic Mail Notice List.

I certify that a true and correct copy of the foregoing document was filed electronically with the United States Bankruptcy Court, and has been served by Regular United States Mail Service, first class, postage fully pre-paid, addressed to to the parties listed below on the ___ day of _______, 20__.

/s/ __________________________

Attorney Name, Fed. & State Bar #

Attorney for Movant/Debtor

Address

City, State, Zip Code

Phone: Fax:

e-mail

(L.F. 1 Rev.12-17)