L.B.F . 1009 - 1.1 (12/1 8 ) Page 1 Fill in this information to identify your case UNITED STATES BANKRUPTCY COURT DISTRICT OF COLORADO Debtor 1 : Case #: First Name Middle Name Last Name Debtor 2: Chapter : First Name Middle Name Last Name Local Bankruptcy Form 1009 - 1.1 Notice of Amendment of Petition, List s , Schedule s , Statement s , and/or Addition of Creditors Please check applicable boxes, complete applicable sections identifying each amendment, an d attach additional pages as necessary . You are hereby notified that the d ebtor has filed amended documents: [petition/list(s)/schedule(s)/statement(s), and/or addition of creditor(s)] . 2.1. Petition Not applicable (no amendments to Petition) The following section(s) of the Petition are amended as follows: Section of Petition Information before amendment New information 2.2. List(s) Not applicable (no amendments to List(s)) The following List(s) are amended as follows: List Information before amendment New information List(s): Part 1 Notice Part 2 Amendments American LegalNet, Inc. www.FormsWorkFlow.com L.B.F . 1009 - 1.1 (12/1 8 ) Page 2 2.3. Schedule(s) Not applicable (no amendments to Schedules) Schedule(s) are amended as follows: Schedules A/B: Description of p roperty Interest in p roperty Current value of entire property Current value of portion owned Schedule C: Amount of the e xemption you claim If you object to this amended claim of exemption, you must file and serve your objection within 30 days after the date this notice is served. Objections must be filed with the Court and a complete copy must be served on attorney or debtor, if unr epresented . Schedule D: New creditor or Amendment to existing creditor digits of account #, mailing address Claim amount Collateral Collateral value Any other changes New creditor Amendment to existing creditor New creditor Amendment to existing creditor Schedules E/F: New creditor or Amendment to existing creditor 4 digits of account #, mailing address Total claim amount Priority amount (if any) Any other changes New creditor Amendment to existing creditor New creditor Amendment to existing creditor Schedule G: Contracting/Leasing party and address What the contract of lease is for Schedule H: Co - debtor/spouse, former spouse, or legal equivalent; name and address Creditor to whom you owe the debt/community state or territory American LegalNet, Inc. www.FormsWorkFlow.com L.B.F . 1009 - 1.1 (12/1 8 ) Page 3 Schedules I/J: Amended/New i nformation 2.4. Statement(s) Not applicable (no amendments to Statement(s)) The following Statement(s) are amended as follows: Statement Information before amendment New information 2.5. Addition of Creditor(s) Not applicable (no additions) Creditors have been added as follows ( and Schedules D, E, or F have been amended accordingly ): Creditors have been amended as follows: or address: Creditor s name and/or address before amendment Dated: By: Signature Bar Number (if applicable): Mailing Address: Telephone number: Facsimile number: E - mail address: Part 3 or Debtor (if unrepresented) American LegalNet, Inc. www.FormsWorkFlow.com