REVISED 12/15 UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA In re: Debtor(s). SIGNATURE DECLARATION PETITION, SCHEDULES & STATEMENTS CHAPTER 13 PLAN VOLUNTARY CONVERSION, SCHEDULES & STATEMENTS AMENDMENT TO PETITION, SCHEDULES & STATEMENTS MODIFIED CHAPTER 13 PLAN OTHER: PLEASE DESCRIBE: I [We], the undersigned debtor(s) or authorized representative of the debtor, make the following declarations under penalty of perjury: 1. 2 The information I have given my attorney for the electronically filed petition, statements, schedules, amendments, and/or chapter 13 plan, as indicated above, is true and correct; The Social Security Number or Tax Identification Number I have given to my attorney for entry into the court's Case Management/Electronic Case Filing (CM/ECF) system as a part of the electronic commencement of the above-referenced case is true and correct; [individual debtors only] If no Social Security Number was provided as described in paragraph 2 above, it is because I do not have a Social Security Number; I consent to my attorney electronically filing with the United States Bankruptcy Court my petition, statements and schedules, amendments, and/or chapter 13 plan, as indicated above, together with a scanned image of this Signature Declaration; My electronic signature contained on the documents filed with the Bankruptcy Court has the same effect as if it were my original signature on those documents; and [corporate and partnership debtors only] I have been authorized to file this petition on behalf of the debtor. Case No. 3. 4 5. 6. Date: x Signature of Debtor 1 or Authorized Representative Printed name of Debtor 1 or Authorized Representative x Signature of Debtor 2 Printed Name of Debtor 2 American LegalNet, Inc. www.FormsWorkFlow.com