Fill and Sign the Debtor Case Form

United States Bankruptcy Court ________________ District Of ________________ In re:       Debtor Case No.       Chapter       SUMMONS TO DEBTOR IN INVOLUNTARY CASE To the above named debtor: A petition under title 11, United States Code was fled against you on       (date) in this bankruptcy court, requesting an order for relief under chapter       of the Bankruptcy Code (title 11 of the United States Code). YOU ARE SUMMONED and required to fle with the clerk of the bankruptcy court a motion or answer to the petition with in 20 days after the service of the summons. A copy of the petition is attached. Address of Clerk       At the same time you must also serve a copy of your motion or answer on petitioner's attorney. Name and Address of Petitioner's Attorney       If you make a motion, your time to serve an answer is governed by Bankruptcy Rule 1011(c). If you fail to respond to this summons, the order for relief will be entered. Clerk of the Bankruptcy Court By: Date Deputy Clerk LF-55 (rev. 05/08/01) Page 1 of 4 *Set forth all names, including trade names, used by the debtor within the last 6 years. (Bankruptcy Rule 1005). LF-55 (rev. 05/08/01) Page 2 of 4 Case No.       CERTIFICATION OF SERVICE I,       of       certify: That I am, and at all times hereinafter mentioned was, more than 18 years of age; That on the day of , 20 I served a copy of the within summons, together with the petition fled in this case, on the debtor in this case, by [describe here the mode of service] the said debtor at I certify under penalty of perjury that the foregoing is true and correct. Executed on (Date) (Signature) LF-55 (rev. 05/08/01) Page 3 of 4 ** State mailing address LF-55 (rev. 05/08/01) Page 4 of 4