Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY Attorney for UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: CHAPTER _______ CASE NUMBER Debtor. (No Hearing Required) DECLARATION RE: LIMITED SCOPE OF APPEARANCE PURSUANT TO LOCAL BANKRUPTCY RULE 2090-1 TO THE COURT, THE DEBTOR, THE TRUSTEE (if any), AND THE UNITED STATES TRUSTEE: 1. I am the attorney for the Debtor in the above-captioned bankruptcy case. 2. On (specify date) _________________________, I agreed with the Debtor that for a fee of $______________, I would provide only the following services: a. Prepare and file the Petition and Schedules b. Represent the Debtor at the 341(a) Meeting c. Represent the Debtor in any relief from stay actions d. Represent the Debtor in any proceeding involving an objection to Debtor’s discharge pursuant to 11 U.S.C. § 727 Represent the Debtor in any proceeding to determine whether a specific debt is nondischargeable under 11 U.S.C. § 523 Other (specify): e. f. 3. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct and that this declaration was executed on the following date at the city set forth in the upper left-hand corner of this page. Dated: _______________________________________ Law Firm Name I HEREBY APPROVE THE ABOVE: By: ____________________________________ _____________________________________ Signature of Debtor Name: _________________________________ Attorney for Debtor This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2090-1.1 Declaration Re: Limited Scope of Appearance - Page 2 In re F 2090-1.1 CHAPTER _______ Debtor. CASE NUMBER NOTE: When using this form to indicate service of a proposed order, DO NOT list any person or entity in Category I. Proposed orders do not generate an NEF because only orders that have been entered are placed on a CM/ECF docket. PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document described as will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d), and (b) in the manner indicated below: I. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s) (“LBR”), the foregoing document will be served by the court via NEF and hyperlink to the document. On ________________________ I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email addressed indicated below: G Service information continued on attached page II. SERVED BY U.S. MAIL OR OVERNIGHT MAIL (indicate method for each person or entity served): On _________________________ I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States Mail, first class, postage prepaid, and/or with an overnight mail service addressed as follow. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page III. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (indicate method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on _______________________ I served the following person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method) by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. _________________________________________________________ Date Type Name _____________________________________ Signature This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2090-1.1 Declaration Re: Limited Scope of Appearance - Page 3 In re F 2090-1.1 CHAPTER _______ Debtor. CASE NUMBER ADDITIONAL SERVICE INFORMATION (if needed): This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 2090-1.1