CSD 1801 [12/01/16] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. DECLARATION RE: ELECTRONIC FILING OF PETITION, SCHEDULES & STATEMENTS PART I - DECLARATION OF PETITIONER I [We] and , the debtor(s), hereby declare under penalty of perjury that the information I have given my attorney and the information provided in the electronically filed petition, statements, and schedules is true and correct. I consent to my attorney sending my petition, this declaration, statements and schedules to the United States Bankruptcy Court. I understand that this Declaration Re: Electronic Filing is to be filed with the Clerk once all schedules have been filed electronically but, in no event, no later than 14 days following the date the petition was electronically filed. I understand that failure to file the signed original of this Declaration will cause my case to be dismissed pursuant to 11 U.S.C. §707(a)(3) without further notice. [If petitioner is an individual whose debts are primarily consumer debts and has chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12 or 13 of 11 United States Code, understand the relief available under each such chapter, and choose to proceed under chapter 7. I request relief in accordance with the chapter specified in this petition. [If petitioner is a corporation or partnership] I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance with the chapter specified in this petition. Dated: Signed *(Debtor) PART II - DECLARATION OF ATTORNEY I declare under penalty of perjury that I have informed the petitioner, if an individual, that [he or she] may proceed under chapter 7, 11, 12 or 13 of Title 11, United States Code, and have explained the relief available under each such chapter. I further certify that I have delivered to the debtor the notice required by 11 U.S.C. §342(b). In a case in which § 707(b)(4)(D) applies, this signature also constitutes a certification that I have no knowledge after an inquiry that the information in the schedules is incorrect. Dated: *(Joint Debtor) *If filed electronically, pursuant to LBR 5005-4(C), the original debtor signature(s) in a scanned format is required. Attorney for Debtor(s) CSD 1801 American LegalNet, Inc. www.FormsWorkFlow.com