United States Bankruptcy Court Central District of Illinois In re_________________ Debtor(s) Case No._____________ Declaration of Exemption From Means Test NOTE: In joint cases that involve non-consumer debts, this determination must be made for each debtor, separately, based upon each debtor’s personal liability for non-consumer debts. For Individual Debtor: DEBTOR declares under penalty of perjury that he/she is not an individual with primarily consumer debts as that term is defined by Section 101(8) of the Bankruptcy Code. For purposes of this determination, “primarily” means more that fifty percent of the DEBTOR’S total debt. For Joint Debtors: Each of the undersigned DEBTORS declares under penalty of perjury that he/she is not an individual with primarily consumer debts as that term is defined by Section 101(8) of the Bankruptcy Code. For purposes of this determination, “primarily” means more than fifty percent of each individual DEBTOR’S total debt. Date: Signature: (Debtor) Date: Signature: (Joint Debtor, if any) American LegalNet, Inc. www.USCourtForms.com