UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW MEXICO In re _________________________________ _________________________________ _________________________________ _________________________________ [Name of debtor(s) + last 4 digits of SSN], Debtor(s). No. _____________________________ [case number, e.g., 7-03-13131 MR] AMENDED STATEMENT OF SOCIAL SECURITY NUMBER Debtor (enter full name): __________________________________________________ I have a social security number and it is: ________________________________ I do not have a social security number. I declare under penalty of perjury that the foregoing is true and correct. Date: ____________________ ___________________________________ Debtor signature Instructions to debtor: In a joint case, use a separate form for each debtor if the statement of social security number for each debtor is being amended. Amended statement of social security number is required pursuant to Fed. R. Bankr. P. 1007(f). Penalty for making a false statement: Fine of up to $250,000 or up to 5 years imprisonment or both. 18 U.S.C. §§ 152 and 3571 K:\_WEB\public\Files\forms\formB21amd.wpd Form B21 amd American LegalNet, Inc. www.FormsWorkflow.com