LBF 5005-4A UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW HAMPSHIRE (rev 12/01/03) In re: Bk. No. *-JMD or -MWV Chapter * *, Debtor(s), Full Social Security Number(s) DECLARATION REGARDING ELECTRONIC FILING PART 1 - Declaration of Petitioner: I [We] _______________________ and _______________________, the undersigned debtor(s), corporate officer, partner or managing member, hereby declare under penalty of perjury that the information I have given my attorney and the information contained in the electronically filed petition, statements and schedules, or amendments thereof (the “petition and schedules”), consisting of ___ pages, is true and correct, to the best of my knowledge and belief. I understand that this DECLARATION REGARDING ELECTRONIC FILING is to be filed with the Clerk after the petition and schedules have been filed electronically but, in no event, no later than 5 business days after the petition and schedules have been filed. I acknowledge receipt of a copy of the electronically filed petition and schedules. 9 [If petitioner is an individual whose debts are primarily consumer debts and has chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12, or 13 of title 11 of the United States Code, understand the relief available under each such chapter, and choose to proceed under chapter 7. I request relief in accordance with the chapter specified in the petition. I declare under penalty of perjury that the foregoing social security number is true and correct. 9 [If petitioner is a corporation, partnership or limited liability entity] I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance with the chapter specified in this petition. I understand that failure to file the signed original of this DECLARATION is grounds for dismissal of my case pursuant to 11 U.S.C. § 707(a)(3). Dated: _______________________________ _________________________________________ Authorized Corporate Officer/Partner/Managing Member Signed: ______________________________ Debtor _________________________________________ Joint Debtor (if joint case, both spouses must sign) Part 2 - Declaration of Attorney: I declare that, to the best of my knowledge, information and belief, formed after an inquiry reasonable under the circumstances, that the petition and schedules are not being presented for any improper purpose; that the claims, defenses, and other legal contentions therein are warranted and are not frivolous; that the allegations and other factual contentions have, or will have, evidentiary support; and that the denials of factual contentions are warranted. I further certify that the debtor(s) signed this Declaration and authorized me to electronically file the petition and schedules, that I gave the debtor(s) a copy of the electronically filed petition and schedules, and that the petition and schedules identified in the attached Notice of Electronic Filing from the CM/ECF system fully and accurately reflect the information given to me by the debtor(s). I have complied with all other electronic filing requirements. I have informed the individual petitioner that [he and/or she] may proceed under chapter 7, 11, 12 or 13 of title 11of the United States Code, and have explained the relief available under each such chapter. This declaration is based upon all information of which I have knowledge. Dated: ________________________________ _________________________________________ Attorney for Debtor(s) Attach the Notice of Electronic Filing as an Exhibit. (FILE ORIGINAL WITH COURT. DO NOT FILE ELECTRONICALLY.) American LegalNet, Inc. www.FormsWorkflow.com