UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF OHIO WESTERN DIVISION IN RE: ___________________________________ ___________________________________ Debtor(s) CASE NO.:______________________ JUDGE: ________________________ Amendment to Petition, Schedules, Creditor Matrix, Statement of Financial Affairs Pursuant to Bankruptcy Rule 1009 The attachments hereto amend the following: ________A/B ________C ________D ________E/F ________G ________H ________I ________J ________Summary of Schedules _________Matrix ________Statement of Financial Affairs _________Other _________________________________________________ Debtor(s) represent that the amendments attached contain full and true statements of facts set forth therein, as required by the provisions of Title 11 United States Code and Federal Bankruptcy Rules of Procedure and/or Local Bankruptcy Rules relating to the debtor. Pursuant to Bankruptcy Rule 1008, Debtor(s) _______________________ and _________________________ certify under penalty of perjury that the foregoing is true and correct. Executed on:__________________ _____________________________________ Signature of Debtor ______________________________________ Signature of Debtor American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE (Service addresses for Creditors and Parties-in-Interest must be listed as per LBR 9013-3) Pursuant to Bankruptcy Rule 1009(a), I certify that on this _______ day of ______________, 20____, a copy of this amendment, together with a copy of the Notice of Commencement of Case and Meeting of Creditors, was sent to the following additional creditors or original creditors with corrected addresses, United States Trustee and case Trustee at the addresses listed below or attached hereto: Name: ______________________________ Address:_____________________________ ______________________________ Name:__________________________________ Address: ________________________________ ________________________________ Name: ______________________________ Address:_____________________________ ______________________________ Name:__________________________________ Address: ________________________________ ________________________________ Name: ______________________________ Address:_____________________________ ______________________________ Name:__________________________________ Address: ________________________________ ________________________________ Name: United States Trustee Case Trustee:____________________________ Address: ________________________________ ________________________________ Address:_____________________________ ______________________________ By:_______________________________________ Signature of Pro Se Debtor or Attorney - Original must be filed with the Clerk's Office. Mandatory electronic filers are required to submit this form and all amended attached documents via the Court's electronic filing system. - Amendments adding creditors must be accompanied by a matrix listing only the creditor names and addresses being added. Electronic filers must upload creditor address changes at time of filing. See LBR 1007-2. - Amendments or changes to the matrix or list of creditors may require a filing fee. American LegalNet, Inc. www.FormsWorkFlow.com