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Power of Attorney Employer to Pay Wages Form


To: ______________________(Debtors employer)


ATTENTION: Finance OfficeDisbursing Branch

I, the undersigned employee, filed a voluntary petition under section 301 of the Bankruptcy Code in the United States Court of Bankruptcy for the ______________ District of __________, initiating proceedings for adjustment of my debts as an individual with regular income under chapter 13 of the Code, by which I am seeking to obtain an extension of time within which to pay my debts pursuant to a plan filed by me; and

The terms of my plan require me to pay to the standing trustee specified amounts of money from each payment to me of wages or salary; and,

I would like to give to the court and to my creditors a reasonable assurance, in addition to my own promise, that each and every payment required of me under such plan will be paid when due, and I have agreed and represented to them that I will have my wage or salary checks, during the pendency of my case, sent directly through the United States mail to the standing trustee;

Now, therefore, I constitute and appoint _____________ (name), standing trustee, and ____________ (his or her) successors as such, as my true and lawful agent and attorney in fact to receive delivery from you, my employer, of each check, draft, or other pay medium of all wages or salary, or both, hereafter due to me as compensation for my services as your employee, until written notice to the contrary is given by the court to you; and I authorize and direct you, unless notified in writing to the contrary by the court, to transmit each such check, draft, or other means of payment through the United States mails, or by such other reasonable means as you may choose, to me in care of or to __________________Standing Trustee, _________________(address), including __________ (his or her) successors as such; and I consent, agree, and request that the above be done. I do further authorize such attorney in fact to endorse my name on any such pay medium, collect the proceeds, and pay from such proceeds any sums then due on my plan, if I fail to make such endorsement and payment within a reasonable time after issuance of such pay medium.

Dated ____________, 20 __.





Subscribed and sworn to before me on: __________________.