Rev. 12/15 UNITED STATES BANKRUPTCY COURT DISTRICT OF NORTH DAKOTA IN RE: Bankruptcy No: Chapter: Debtor(s) AMENDMENT COVER SHEET Schedules and Statements Amended (check all that apply): G Voluntary Petition (describe change)_________________________________________ G Summary of Assets and Liabilities and Certain Statistical Information G Schedule A/B � Property G Schedule C � The Property You Claim as Exempt G Schedule D � Creditors Who Hold Claims Secured By Property G Schedule E/F � Creditors Who Have Unsecured Claims G Schedule G � Executory Contracts and Unexpired Leases G Schedule H � Codebtors G Schedule I � Your Income G Schedule J � Your Expenses G Declaration Concerning Schedules G Statement of Financial Affairs G Attorney's Disclosure of Compensation G Statement of Intention for Individuals Filing Under Chapter 7 G Statement of Current Monthly Income G Other _________________________ If amending schedules D or E/F, the amendment is to: G Add new creditor(s) (Notice to Creditor(s) of Amended Schedule(s) must be served and filed) G Correct or delete information Describe changes made: (Examples: Added or Reclassified Creditor "X"; Add or modified exempt property "X") DECLARATION I certify under penalty of perjury that the foregoing is true and correct, and that the attached amendments are true and correct. DATED: __________________ Signature __________________________________________ Debtor1 __________________________________________ Debtor2 American LegalNet, Inc. www.FormsWorkFlow.com