UNITED STATES BANKRUPTCY COURT District of Colorado In re BANKRUPTCY NO. CHAPTER Debtor(s). DECLARATION RE: ELECTRONIC FILING OF PETITION, SCHEDULES & STATEMENTS, AND STATEMENT OF SOCIAL SECURITY NUMBER(S) PART I - DECLARATION OF PETITIONER I (WE) SSN SSN , and the undersigned debtor(s), hereby declare under penalty of perjury that I/we have read the electronically filed petition, statements, schedules, lists and any amendment thereto, or other document indicated below, as well as the information appearing above, and that the information contained therein is true and correct. 9 Petition, statement of affairs, schedules or lists 9 Amendments to the petition, statement of affairs, schedules or lists 9 Other: I consent to my attorney sending such petition, this declaration, statements, schedules, lists and amendments thereto to the United States Bankruptcy Court by electronic means. I understand that this DECLARATION RE: ELECTRONIC FILING is to be filed with the Clerk of the Court no later than 10 business days following the date the petition was electronically filed. I understand that failure to file the signed original of this DECLARATION may cause my case to be dismissed pursuant to 11 U.S.C. § 707(a)(3) without further notice. 9 9 9 If petitioner is an individual whose debts are primarily consumer debts and who has chosen to file under chapter 7: I am aware that I may proceed under chapter 7, 11, 12 or 13 of Title 11, United States Code, understand the relief available under each 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 herein. If petitioner files an application to pay filing fee in installments: I certify that I completed an application to pay the filing fee in installments. I am aware that the bankruptcy case will be dismissed and I may not receive a discharge of my debts if the fee is not paid within 120 days of the date of filing the petition. Dated: Signed: (Applicant) (Joint Applicant) PART II - DECLARATION OF ATTORNEY I declare under penalty of perjury that the debtor(s) signed this form before I electronically transmitted the petition, schedules, and statements to the United States Bankruptcy Court, and have followed all other requirements in Amended General Procedure Order No. 2001-8. If an individual, I further declare that I have informed the petitioner 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 chapter. This declaration is based on information of which I have knowledge. Dated: Attorney Name, Address, Telephone, E-Mail, and Bar No. Instructions: Pursuant to Rule 1007(f), Federal Rules of Bankruptcy Procedure and Local Bankruptcy Rule 911(c), this form must be executed by the Debtor(s) and the attorney for the Debtor(s) and submitted to the Clerk within ten (10) days after electronic filing of the petition or related documents for secured record-keeping. Although this form shall be permanently retained by the Clerk, the form shall not be docketed, stored with or become part of the official records of the case, nor shall it be subject to public inspection or disclosure. American LegalNet, Inc. www.USCourtForms.com