DeBN 03/16 UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA In re: __________________________________________________ Case No. ____________ DEBTOR'S ELECTRONIC NOTICING REQUEST (DeBN) Check only one box for the applicable section below. INITIAL ACTIVATION REQUEST (Check this box to begin receiving notices and orders from the U.S. Bankruptcy Court via email.) Pursuant to Bankruptcy Rule 9036, I request receipt of court notices and orders via email, instead of U.S. mail, from the Bankruptcy Noticing Center (BNC) through the U.S. Bankruptcy Court's Debtor Electronic Bankruptcy Noticing (DeBN) program. I understand that my email address will appear on any certificate of mailing filed with the court by the electronic noticing provider. I understand that this request for electronic notice is limited to notices and orders entered by the U.S. Bankruptcy Court only. I will continue to receive documents filed by all other parties, such as the trustee and creditors, via U.S. mail or in person pursuant to court rules. I understand that I will receive electronic notice of court notices and orders from any bankruptcy court in the U.S. in any current or future bankruptcy case or adversary proceeding in which I am listed with the same name and address, including cases where I am listed as a creditor. I understand that the first time the BNC receives an email bounce-back (undeliverable email), my DeBN account will be automatically disabled. I will then receive notices and orders via U.S. mail, and I must file an updated request form if I wish to reactivate me account. I understand that enrollment in DeBN is completely voluntary, and I may file a request to deactivate my account at any time. UPDATE TO ACCOUNT INFORMATION (Check this box to make changes to your existing DeBN account.) I request the following updates(s) to my DeBN account: I have a new email address as indicated below. I filed a new bankruptcy case, and I have an existing DeBN account. Please review my account to ensure my name and address in my account match this new case. I request reactivation of my DeBN account so that I may receive court notices and orders via email, instead of U.S. mail. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DeBN 03/16 REQUEST TO DEACTIVATE ELECTRONIC NOTICING (Check this box to request deactivation of your DeBN account.) I request deactivation of my DeBN account. I understand that by deactivating my account, I will begin receiving notices and orders entered by the U.S. Bankruptcy Court via U.S. mail, instead of email. I understand that I will continue to receive electronic notices until such time as the Court has deactivated my account. Under penalty of perjury, I certify that I am a debtor in this bankruptcy case, or the debtor's authorized representative if the debtor is a corporation or partnership, and I have read the applicable section check-marked above and understand and agree to its terms and conditions. Neither the U.S. Bankruptcy Court nor the BNC bears any liability for errors resulting from the information I have stated on this form. Joint debtors who each request enrollment must file separate forms. Debtor Signature: __________________________________________ Date: ______________ Printed Name (and title if a corporation or partnership): ____________________________________________________________________________ Email Address: _______________________________________________________________ Phone Number: _______________ For more information about the DeBN program, visit the Court's website at: www.mnb.uscourts.gov Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com