BTXN 170 IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF TEXAS IN RE: ____________________________ Debtor(s) § § § § § Case No. _________________ Chapter _____ DECLARATION FOR ELECTRONIC FILING OF BANKRUPTCY PETITION AND MASTER MAILING LIST (MATRIX) PART I: DECLARATION OF PETITIONER: As an individual debtor in this case, or as the individual authorized to act on behalf of the corporation, partnership, or limited liability company seeking bankruptcy relief in this case, I hereby request relief as, or on behalf of, the debtor in accordance with the chapter of title 11, United States Code, specified in the petition to be filed electronically in this case. I have read the information provided in the petition and in the lists of creditors to be filed electronically in this case and I hereby declare under penalty of perjury that the information provided therein, as well as the social security information disclosed in this document, is true and correct. I understand that this Declaration is to be filed with the Bankruptcy Court within five (5) business days after the petition and lists of creditors have been filed electronically. I understand that a failure to file the signed original of this Declaration will result in the dismissal of my case. G [Only include for Chapter 7 individual petitioners whose debts are primarily consumer debts] – I am an individual whose debts are primarily consumer debts and who has chosen to file under chapter 7. I am aware that I may proceed under chapter 7, 11, 12, or 13 of title 11, United States Code, understand the relief available under each chapter, and choose to proceed under chapter 7. G [Only include if petitioner is a corporation, partnership or limited liability company] – I hereby further declare under penalty of perjury that I have been authorized to file the petition and lists of creditors on behalf of the debtor in this case. Date: _____________. ___________________________ Debtor ___________________________ Joint Debtor PART II: DECLARATION OF ATTORNEY: I declare under penalty of perjury that: (1) I will give the debtor(s) a copy of all documents referenced by Part I herein which are filed with the United States Bankruptcy Court; and (2) I have informed the debtor(s), if an individual with primarily consumer debts, that he or she may proceed under chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each such chapter. Date: _____________. _________________________ Attorney for Debtor American LegalNet, Inc. www.USCourtForms.com