B6 Declaration (Official Form 6 - Declaration) (12/07) In re _________________________________________ , Debtor Case No. ______________________________ (if known) DECLARATION CONCERNING DEBTOR'S SCHEDULES DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of _____ sheets, and that they are true and correct to the best of my knowledge, information, and belief. Date __________________________________ Signature: ________________________________________________ Debtor Date __________________________________ Signature: ________________________________________________ (Joint Debtor, if any) [If joint case, both spouses must sign.] ------------------------------------------------------------------------------------------------------------------------------------------DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h) and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required by that section. _____________________________________________________ Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer _____________________________ Social Security No. (Required by 11 U.S.C. § 110.) If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person, or partner who signs this document. _________________________________ _________________________________ _________________________________ Address X _____________________________________________________ Signature of Bankruptcy Petition Preparer ____________________ Date Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer is not an individual: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF A CORPORATION OR PARTNERSHIP I, the __________________________________ [the president or other officer or an authorized agent of the corporation or a member or an authorized agent of the partnership ] of the ___________________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of ___ sheets (Total shown on summary page plus 1), and that they are true and correct to the best of my knowledge, information, and belief. Date ______________________________________ Signature: _____________________________________________________________ ____________________________________________________________ [Print or type name of individual signing on behalf of debtor.] [An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.] ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571. American LegalNet, Inc. www.FormsWorkflow.com