MOW 1009- 1.1 [replaces MOW 1009-1.1 and 1.2] (6/14) IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF MISSOURI IN RE: ) ) ) ) Case No. Debtor(s) VERIFICATION BY DEBTOR(S) I/We, , named as the debtor(s) in this case, declare under the penalty of perjury that I/we have read the Schedule(s) ________________ (A - J insert all that apply) Amended Schedule(s) __________________ (A - J insert all that apply) Conversion Schedules __________________ (A - J insert all that apply) Statement/Amended Statement of Financial Affairs Statement/Amended Statement of Intent Statement/Amended Statement of Current Monthly Income Matrix Amended Matrix and that they are true and correct to the best of my/our knowledge, information, and belief. Date: Signature of Debtor Signature of Joint Debtor Instructions: File with original schedules or matrix not filed with the original petition or amended schedules/statements/matrix. Must be prepared as a separate document and must contain image of the debtor(s)' signature(s). Docket as a separate event or as a separate attachment to the schedules/statements/matrix. ECF Event: If not filed as an attachment to the schedules/statements/matrix, but filed as a separate document use the event ­ Bankruptcy>Other>Verification by Debtor American LegalNet, Inc. www.FormsWorkFlow.com