B132 (Form 132) (11/11)

UNITED STATES BANKRUPTCY COURT

_______________ District Of _______________

APPLICATION FOR SEARCH OF BANKRUPTCY RECORDS *

Name of individual or business that is thesubjectof the search:

Social-Security No. or Individual Taxpayer-Identification No. (ITIN) of Subject:

Employer Tax-Identification No. (EIN) (ifany) of Subject:

Please search your records for the following information regarding the individual or businessnamed above:

G pending or closed bankruptcy cases in this district;G pending or closed adversary proceedings;G judgments/evidence of satisfaction of judgments; andG other [describe briefly]

Please search for the period from _____________________________to________________________________.

A fee of $30.00 is charged for each name or item searched. Payment by check or money ordermust be enclosed. Please do not send cash through the mail.

Name, address, and phone number of the person requesting the search:

CERTIFICATE OF SEARCH

The undersigned clerk hereby certifies the following results of a diligent search of the records ofthe court:[Check only the items for which a search was requested and a fee paid.]

A. Bankruptcy Cases:G None found.G Case filed on (date).

G Voluntary G InvoluntaryG Pending G Closed on (date).G Discharge granted on (date).

B. Adversary Proceedings:G None found.

G Subject is a party to the following proceeding:

(Plaintiff) v. (Defendant)

Adversary Proceeding No. , filed on (date).

G Pending G Closed on (date).Disposition: G Dismissed on (date)

G Final Judgment entered on (date)Case Number of Related Bankruptcy Case ______________________

Clerk of theBankruptcy Court

Date: By: Deputy Clerk

* This form may contain complete social-security numbers. It should not be filedelectronically.