UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF NEW YORK
------------------------------------------------------------------X
Case No.:
In re:  							
             	,			Chapter 7


Debtors(s)*
------------------------------------------------------------------X

STATEMENT OF SOCIAL SECURITY NUMBER(S)

1.	Name of Debtor (enter Last, First, Middle):                                                                     
            (Check the appropriate box and, if applicable, provide the required information)

        	? Debtor has a Social Security Number and it is :        -           -          
                             (If more than one, state all.)
              
? Debtor does not have a Social Security Number.

2.	Name of Joint Debtors (enter Last, First, Middle):                                                           
            (Check the appropriate box and, if applicable, provide the required information)

? Joint Debtor has a Social Security Number and it is :        -           -          
                             (If more than one, state all.)
              
? Joint Debtor does not have a Social Security Number.


I declare under penalty of perjury that the foregoing is true and correct.


X                                                                                                               
Signature of Debtor 			Date


X                                                                                                                 
Signature of Joint Debtor		Date

                                                                                                                                                      
      
*Joint Debtors must provide information for both spouses.
Penalty for making a false statement: Fine of up to $250,000.00 or up to 5 years 
imprisonment or both.  18 U.S.C. Sections 152 and 3571.