UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI ____________DIVISION In re DEBTOR NAME, ) ) Case No.___-________-___ ) Chapter ___ Debtor(s). ) Verification of Creditor Matrix The above named debtor(s) hereby certifies/certify under penalty of perjury that the attached list containing the names and addresses of my creditors (Matrix), consisting of _____ page(s) and is true, correct and complete. __________________________________________ Debtor __________________________________________ Joint Debtor Dated: ___________________ (L.F. 2 Rev. 05/03)