(Rev. 10/3/2016)

This document should be electronically filed.

To ensure the privacy of the debtor's Social Security number always separate this pleading into it's own PDF file. The Statement of Social Security Number should not be combined with the voluntary petition and schedules. 

 For electronic filing procedures, click:

• Statement About Your Social Security Number (Official Form 121) or 
• Statement About Your Social Security Numbers (Official Form 121) (AMENDED STATEMENT)