UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW HAMPSHIRE In re: _________________________________, Debtor Bk. No. ________-_________-_______ Chapter ______ AMENDMENT COVER SHEET An amendment to the following petition, lists, schedules or statements is transmitted herewith: _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ Voluntary petition Schedule A - Real Property1 Schedule B - Personal Property1 Schedule C - Property Claimed as Exempt Schedule D - Creditors Holding Secured Claims1, 2 Schedule E - Creditors Holding Unsecured Priority Claims1, 2 Schedule F - Creditors Holding Unsecured Nonpriority Claims1, 2 Schedule G - Executory Contracts and Unexpired Leases Schedule H - Co-Debtors Schedule I - Current Income of Individual Debtor (entire Schedule I, as amended, and Schedule J, as amended, also attached)1,3 Schedule J - Current Expenditures of Individual Debtor (entire Schedule I and Schedule J, as amended, also attached)1,3 Summary of Schedules1 Creditor Matrix2 Statement of Financial Affairs Chapter 7 Individual Debtor's Statement of Intention Disclosure of Compensation of Attorney for Debtor Social Security Number3 Form B22 (Statement of Current Monthly Income) Other [Please specify:_______________________________] In connection with the filing of this amendment, I acknowledge that I have read and understood the terms of LBR 1009-1. _____________________________________ Attorney or Pro se Debtor Signature _____________________________________ Print Name Address_______________________________ _____________________________________ Tel. No._______________________________ --------------------------------------------------------------------------------------------------------------------------------------------------Attach both pages of amended Official Form 6, "Summary of Schedules/Statistical Summary of Certain Liabilities and Related Data (28 U.S.C. § 159)." 1 2 Date: ___________________ Fee submitted for Amendment to Schedules D, E or F or the creditor matrix. No fee is required to change the address of a creditor or to add the name and address of an attorney for a listed creditor. 3 Any amendment to Schedule I requires an amendment to Schedule J. Schedule I must always be filed with any amendment to Schedule J. Amendment of the debtor's Social Security number requires that an amended LBF 5005-4 or Official Form 21 -- Statement of Social Security Number be submitted to the clerk's office, in addition to the filing of the amendment. The amendment must comply with the final four digit Social Security number requirement of Bankruptcy Rule 1005, while the copy mailed to affected parties must list the complete Social Security number. 4 LBF 1009-1A (Eff. 2/1/13) American LegalNet, Inc. www.FormsWorkFlow.com