R.I. Bankr. Form P.3 See R.I. LBR 5005-4 (rev. 12/03) UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF RHODE ISLAND -------------------------- ----* In re: : Debtor(s) : -------------------------- ----* BK No. Chapter DECLARATION REGARDING ELECTRONIC FILING IN SUPPORT OF ORIGINAL PETITION, SCHEDULES, STATEMENTS AND CHAPTER 13 PLAN AND LOCAL FORM V, IF APPLICABLE PART 1 - Declaration of Petitioner: and , the undersigned debtor(s), corporate I [We] officer or partnership member, hereby declare under penalty of perjury that the information I have given my attorney and the information contained in the electronically filed original petition, statements, schedules and Chapter 13 Plan and Local Form V, if applicable (the Aoriginal petition and related schedules, statements, plan and forms@), electronically filed with the Court on , consisting of pages, is true and correct, to the best of my knowledge and belief. I [We] further declare under penalty of perjury that the Social Security number(s) electronically filed with the Court in connection with this bankruptcy filing is [are] true and correct. I understand that this DECLARATION REGARDING ELECTRONIC FILING is to be filed with the Clerk after the original petition and related schedules, statements, plan and forms have been filed electronically but, in no event, no later than 15 days after the original petition and related schedules, statements, plan and forms have been filed. I acknowledge receipt of a copy of the electronically filed original petition and related schedules, statements, plan and forms. I understand that any false information provided knowingly or fraudulently in the petition and schedules 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. ’ [If petitioner is an individual whose debts are primarily consumer debts and has chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12, or 13 of title 11 of the United States Code, understand the relief available under each such chapter, and choose to proceed under chapter 7. I request relief in accordance with the chapter specified in the petition. American LegalNet, Inc. www.FormsWorkFlow.com ’ [If petitioner is a corporation, partnership or limited liability entity] I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance with the chapter specified in this petition. I understand that failure to timely file the signed original of this DECLARATION is grounds for dismissal of my case pursuant to 11 U.S.C. ' 707(a)(3). Dated: ______ Signed: ____________________________________________________ Authorized Corporate Officer/Partnership Member (if applicable) __________________________________________________ Debtor __________________________________________________ Joint Debtor (if joint case, both spouses must sign) Part 2 - 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 debtor(s) signed this Declaration and authorized me to electronically file the original petition and related schedules, statements, plan and forms, that I gave the debtor(s) a copy of the electronically filed original petition and schedules, statements, plan and forms, if applicable, and that the original petition and related schedules, statements, plan and forms identified in the Notice of Electronic Filing from the CM/ECF system fully and accurately reflect the information given to me by the debtor(s). I have complied with all other electronic filing requirements. I have informed the individual petitioner that [he and/or she] may proceed under chapter 7, 11, 12 or 13 of title 11 of the United States Code, and have explained the relief available under each such chapter. This declaration is based upon all information of which I have knowledge. Dated: _______ Attorney for Debtor(s) (FILE ORIGINAL WITH THE COURT. DO NOT FILE ELECTRONICALLY) American LegalNet, Inc. www.FormsWorkFlow.com