UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NEW YORK --------------------------------------------------------------------x In re: Case No. Chapter Debtor(s) --------------------------------------------------------------------x AFFIDAVIT PURSUANT TO LOCAL RULE 1007-1(b) ______________________________, undersigned debtor herein, swears as follows: 1. Debtor filed a petition under chapter______of the Bankruptcy Code on______________________________. 2. Schedule(s)__________were not filed at the time of filing of the said petition, and is/are being filed herewith. 3. [Check applicable box]: G G 4. The schedules filed herewith reflect no additions or corrections to, or deletions from, the list of creditors which accompanied the petition. Annexed hereto is a listing of names and addresses of scheduled creditors added to or deleted from the list of creditors which accompanied the petition. Also listed, as applicable, are any scheduled creditors whose previously listed names and/or addresses have been corrected. The nature of the change (addition, deletion or correction) is indicated for each creditor listed. [If creditors have been added] An amended mailing matrix is annexed hereto, listing added creditors ONLY, in the format prescribed by Local Rule 1007-3. Reminder: No amendment of schedules is effective until proof of service in accordance with EDNY LBR 1009-1(b) has been filed with the Court. Any additions to the list of creditors which accompanied the petition will be deemed an amendment to that list; if this amendment is filed prior to the expiration of the time period set forth in Fed. R. Bankr. P. 4004 and 4007, it will be deemed to constitute a motion for a 30-day extension of the time within which any added creditors may file a complaint to object to the discharge of the debtor and/or to determine dischargeability. This motion will be deemed granted without a hearing if no objection is filed with the Court and served on debtor within 14 days following filing of proof of service of this affirmation, all attachments and the amended schedules in accordance with EDNY LRB 1009-1. Dated:____________________ _______________________________ Debtor (signature) Sworn to before me this_____ day of________________, ____________________________________ Notary Public, State of New York USBC - .64 Rev. 11/1/11 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT PURSUANT TO LOCAL RULE 1007-1(b) Instructions for Completion of Form, Pro Se Debtors Provided your bankruptcy petition was accompanied by a list of all your creditors and their addresses, Bankruptcy Rule 1007(c) allows 14 days from the date of filing of the petition to file your schedules. Pursuant to Local Rule 1007-1(b), schedules filed after the filing of a petition must be accompanied by this affidavit. [NOTE: To the extent that the schedules reflect changes from the list of creditors filed with the petition, the list will be deemed to have been amended. Local Rule 1009-1(a) requires that, in order for an amendment to be effective, proof of service in accordance with Local Rule 1009-1(b) must be filed with the Clerk. The amendment must be served upon the United States Trustee, the Case Trustee, all creditors who were added or deleted, and any other party affected by the amendment. A form of certificate of service is available from the Customer Service Representative at the Clerk’s Office.] In re. Name(s) of debtor(s) as it/they appear on the petition. Case No. The bankruptcy case number assigned at the time of filing of the petition, including the three-digit judge code. EXAMPLE: 103-10345-353 Chapter. The bankruptcy chapter under which relief is being sought (7, 11 or 13). Debtor. Name(s) of debtor(s) signing affidavit. Filed petition under chapter. Re-enter chapter. Filed petition___on. Date petition was filed. Schedule(s). Specify schedule(s) affidavit relates to (D, E, F, G and/or H). Check applicable box. Check the first box if there have been no changes to the list of creditors originally filed. If creditors have been added or deleted, or if corrections have been made, check the second box, and attach a listing of all such creditors. The nature of the change must be indicated for each creditor listed. Matrix. If creditors have been added, an amended matrix must be submitted, listing added creditors ONLY. Signature. The form must be signed by the debtor(s). The date of the signing must be indicated at the prompt on the lower left of the form. Sworn to. You must have the form notarized before presenting it to the Court. * * * FEE: A $30 fee is due if creditors have been added to or deleted from the list of creditors originally filed. (Changing of a creditor’s address does NOT require payment of a fee.) SERVICE OF NOTICE: If creditors have been added, you are responsible for mailing to each such creditor a copy of the notice that the Court issued (and which should have previously been mailed to you) advising of the filing of the case, the meeting of creditors and the fixing of certain deadlines. You should file a certificate of service of the notice along with the schedules. (A form of certificate of service is available at the Clerk’s Office.) Rev. 11/1/11 American LegalNet, Inc. www.FormsWorkFlow.com