ATTY Name Atty Address Atty Address Atty Phone No.: Atty Fax No.: UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF CALIFORNIA In re: Chapter 13 Case No: DECLARATION REGARDING LACK OF INCOME Debtor(s) I, _____________________________ hereby declare the following: I have not received any employment income for the six-month period prior to the month of the filing of this Bankruptcy. I declare this statement is true and correct under penalty of perjury. Executed this ______day of ____________, 20_____, in __________________, California. Debtor American LegalNet, Inc. www.FormsWorkFlow.com