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 OF RENTAL INCOME Debtor(s) I, _____________________________ hereby declare the following: My rental income and rental expenses for the six months prior to the month of the filing of this case are as follows: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: Total Rental Income for ______________ was: Total Rental Expenses for ______________ were: $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ 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