R.I. Bankr. Form P.4-- see R.I. LBR 5005-4 UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF RHODE ISLAND --------------------------* In re: : Debtor(s) : --------------------------* BK No. Chapter DECLARATION REGARDING ELECTRONIC FILING FOR ALL OTHER DOCUMENTS REQUIRING ORIGINAL SIGNATURES PART 1 - Declaration of Declarant: I [We] _____________________________________________________, the undersigned declarant(s), hereby declare under penalty of perjury that I have signed the document identified below and that the information contained in the electronically filed document identified below is true and correct, to the best of my knowledge and belief. I understand that this DECLARATION REGARDING ELECTRONIC FILING is to be filed with the Clerk after the document identified below has been filed electronically but, in no event, no later than 15 days after the document has been filed. I acknowledge receipt of a copy of the electronically filed document. I understand that any false information provided knowingly or fraudulently in the [insert title of document electronically filed requiring original signature] ___________________________________________________________________ may subject me to federal criminal prosecution for concealment of assets, and making false oaths and claims pursuant to 18 U.S.C. § 152, bankruptcy fraud pursuant to 18 U.S.C. § 157, or pursuant to any other applicable federal criminal statute. PART 2 - Identification of Document: [Name of document] __________________________________________________ dated ______________, consisting of ___ pages I understand and agree that failure to timely file the signed original of this DECLARATION is grounds for the Court to strike the document identified above from the record in this proceeding. Dated: ______ ____________________________________ Name: Title: American LegalNet, Inc. www.FormsWorkFlow.com (Insert acknowledgment if required) Part 3 - Declaration of Attorney: I declare that I am familiar with Fed. R. Bankr. P. 9011 and that the representations contained in Fed. R. Bankr. P. 9011(b) are applicable to this filing and such representations are adopted and incorporated herein by reference. I further certify that the declarant signed this Declaration and authorized me to electronically file the document identified above, that I gave the declarant a copy of the electronically filed document identified above, and that the document identified in the Notice of Electronic Filing from the CM/ECF system is the document identified above. Dated:_______ ___________________________________ Name: (FILE ORIGINAL WITH THE COURT. DO NOT FILE ELECTRONICALLY) American LegalNet, Inc. www.FormsWorkFlow.com