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Statement About Your Social Security Numbers

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Official Form 121 Statement About Your Social Security Numbers United States Bankruptcy Court for the: __________ District of __________ Case number (If known): _________________________ Fill in this information to identify your case: Official Form 121 Statement About Your Social Security Numbers 12/15 Use this form to tell the court About any Social Security or federal Individual Taxpayer Identification Numbers you have used. Do not file this form as part of the public case file. This form must be submitted separately and must not be included in the court s public electronic records. Please consult local court procedures for submission requirements. To protect your privacy, the court will not make this form available to the public.

Statement About Your Social Security Numbers 12/15 Use this form to tell the court about any Social Security or federal Individual Taxpayer Identification numbers you have used. Do not …

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