UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-1(b) Case No.: Chapter: In Re: Adv. No.: Hearing Date: Judge: CERTIFICATION OF SERVICE 1. I, : represent in this matter. am the secretary/paralegal for , who represents in this matter. am the in this case and am representing myself. 2. On , I sent a copy of the following pleadings and/or documents to the parties listed in the chart below. 3. I certify under penalty of perjury that the above documents were sent using the mode of service indicated. Date: Signature American LegalNet, Inc. www.FormsWorkFlow.com 2 Name and Address of Party Served Relationship of Party to the Case Mode of Service Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) American LegalNet, Inc. www.FormsWorkFlow.com 3 Name and Address of Party Served Relationship of Party to the Case Mode of Service Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) Hand-delivered Regular mail Certified mail/RR Other (As authorized by the Court or by rule. Cite the rule if applicable.) rev.8/1/16 American LegalNet, Inc. www.FormsWorkFlow.com