UNITED STATES BANKRUPTCY COURT – DISTRICT OF HAWAII Case No.: Debtor: Chapter [circle]: Joint Debtor: 7 11 12 13 15 Documents filed electronically on: DECLARATION re: ELECTRONIC FILING The undersigned understands that this declaration must be filed within 5 business days after the date of electronic filing of the documents identified below and that failure to file a timely declaration may result in dismissal of the case without further notice. Petition Creditor Matrix Schedules AͲJ or __________ Statement of Financial Affairs Check the applicable box: Statement of Current Monthly IncomeͲ B22A,B,C Authorization to File (corp., LLC, partnership) Chapter 7 Statement of Intention List of 20 Largest Unsecured Creditors Notice to Individual Debtor Chapter 13 Plan Amendment: _________________ Other: _______________________ Declaration by Individual / Joint Debtor. I declare under penalty of perjury that the information provided in the document(s) identified above is true and correct. If the document is a petition and my debts are primarily consumer debts and I have 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 of title 11, United States Code, specified in my electronically filed petition. If this filing includes a chapter 13 plan, I certify that the plan has been proposed in good faith, that the information provided in the plan is true and correct, and that I will be able to make all plan payments and otherwise comply with provisions of the plan. I declare under penalty of perjury that the Social Security Number or Individual Taxpayer Identification Number transmitted with my petition is true and correct. Declaration by Corporation / Partnership Debtor. I declare under penalty of perjury that the information provided in the document(s) noted above is true and correct, and that I have been authorized to file the petition on behalf of the debtor. I request relief in accordance with the chapter of title 11, United States Code, specified in the electronically filed petition. Declaration of Foreign Representative. I declare under penalty of perjury that the information provided in the electronically filed petition is true and correct, that I am the foreign representative of a debtor in a foreign proceeding, and that I am authorized to file the petition. I request relief in accordance with chapter 15, United States Code, or with the chapter of title 11 specified in the petition. Involuntary Petition Ͳ Declaration of Petitioning Creditor(s). I declare under penalty of perjury that the information in the electronically filed involuntary petition is true and correct according to the best of my knowledge, information, and belief. The undersigned requests that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in the petition. Signature(s) of Debtor, Joint Debtor, Authorized Individual, Foreign Representative, or Petitioning Creditor(s): X____________________________ X____________________________ X ____________________________ Date: _______________________ Date: _______________________ Date: _______________________ hib_1008Ͳ1dec 12/07 SUBMIT PAPER TO COURT WITH ORIGINAL SIGNATURES – DO NOT FILE USING ECF American LegalNet, Inc. www.FormsWorkflow.com