UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In re: Case No. Chapter Debtor(s) ____________________________________________________________________________________ CERTIFICATE OF SERVICE I, _________________________ certify that on, ____________________________, I served true and correct copies of ___________________________________________ on the following parties in the manner specified for each party below: Name and Address of Party* Method of Service (If by mail, describe the mode of mailing) Dated: ______________________ ______________________________________ * If a corporation, note name of officer, director or managing agent. See Federal Rules of Bankruptcy Procedure 7003, 7004, 9013 and 9014 and additional rules, as applicable, for service requirements. Rev. 10/15/10 American LegalNet, Inc. www.FormsWorkFlow.com