DECLARATION re: ELECTRONIC FILING of Petition and Related Documents UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII 1132 Bishop Street, Suite 250 Honolulu, Hawaii 96813 (Mail or deliver to court with original signatures) Case No.: Debtor: Chapter [circle]: Joint Debtor: O 7 11 12 13 15 hib_5005-4f2 (7/2011) Instructions: This form is required when certain documents are filed electronically by your attorney. Signing this form means that you are declaring, under penalty of perjury, that the information in the documents checked below is true and correct. Do not sign this declaration unless you have read the documents and they are complete and accurate. You or your attorney must mail or deliver this declaration to the court within 7 days after the documents are filed or the court may dismiss your case and/or sanction your attorney. You must also sign the original documents to be retained by your attorney. Petition Creditor Matrix Schedules A-J or _________ Statement of Financial Affairs Statement of Current Monthly Income - 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: _________________ Check the applicable box (see reverse side if this is an involuntary or a chapter 15 case): 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 to the best of my knowledge, information, and belief. 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 to the best of my knowledge, information, and belief, 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. [When signing below, indicate position or relationship to Debtor.] Signature(s) of Debtor and Joint Debtor (if any) or Authorized Individual: X ______________________________________ X ______________________________________ (Sign and print name) (Sign and print name) Date: ___________________________ Date: ___________________________ Sign on reverse side if this is an involuntary or chapter 15 case. American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION re: ELECTRONIC FILING of Petition and Related Documents (Sign this side if this concerns an involuntary petition or chapter 15 case) Involuntary Petition - 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. Declaration of Foreign Representative. I declare under penalty of perjury that the information provided in the electronically filed petition is true and correct to the best of my knowledge, information, and belief, 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. Sign and print name and title: X ________________________ X _________________________ X ________________________ __________________________ ___________________________ ___________________________ Date: ______________________ Date: ______________________ Date: ______________________ American LegalNet, Inc. www.FormsWorkFlow.com