Fill and Sign the 1 67 Sample Master Mailing List Requirements Pursuant to Form

B6 Declaration (Official Form 6 - Declaration) (12/07) In re _________________________________________ ,Case No. ______________________________ Debtor (if known) DECLARATION CONCERNING DEBTOR'S SCHEDULES DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR I declare under penalty of perjury that I have read the fore going summary and schedules, consisting of _____ sheets, and that they are true and correct to the best of my knowledge, information, and belief. Date __________________________________ Signature: ________________________________________________ Debtor Date __________________________________ Signature: ________________________________________________ (Joint Debtor, if any) [If joint case, both spouses must sign.] ------------------------------------------------------------------------------------------------------------------------------ ------------- DECLARATION AND SIGNATURE OF NON-ATTORNEY BANK RUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provide d the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h) and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maxim um amount before preparing any document for f iling for a debtor or accepting any fee from the debtor, as required by that section. _____________________________________________________ _____________________________ Printed or Typed Name and Title, if any, Social Security No. of Bankruptcy Petition Preparer (Required by 11 U.S.C. § 110.) If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number o f the officer, principal, responsible person, or partner who signs this document. _________________________________ __________________________________________________________________ Address X _____________________________________________________ ____________________ Signature of Bankruptcy Petition Preparer Date Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bank ruptcy petition preparer is not an individual: If more than one p erson pr epar ed this do cu m ent, atta ch additional sign ed sh eets confor ming to the appropriate O ffi cial Form for e a ch p erson. A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedur e may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. ------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------- DECLARATION UNDER PENALTY OF PERJURY ON BEH ALF OF A CORPORATION OR PARTNERSHIP I, the __________________________________ [the pr esident or other officer or an authorized agent of the corporation or a member or an authorized agent of the partnership ] of the ___________________________________ [c orporation or partnership] named as debtor in this case, declare und er penalty of perjury that I have read the foregoing summary and schedules, consisting of ___ sheets ( Total shown on summary page plus 1), and that they are true and correct to the best of my knowledge, information, and belief. Date ______________________________________ Signature: _____________________________________________________________ ____________________________________________________________[Print or type name of indivi dual signing on behalf of debtor.] [An individual signing on behalf of a partnership or corpor ation must indicate position or relationship to debtor.] ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571.