IN THE UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF TEXAS In re: § § Case No. DEBTOR'S CERTIFICATION REGARDING NECESSITY OF FILING PAYMENT ADVICES My name is __________________________________________. I am a debtor in this bankruptcy case. I declare that I did not receive any payment advices or other evidence of payment from any employer during the 60 days before the date of the filing of the bankruptcy petition. If this case is a joint case, both spouses have signed below to make this declaration jointly with respect to both. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Executed on __________________________________ (date). Signature of Debtor Signature of Joint Debtor (if joint case) American LegalNet, Inc. www.FormsWorkFlow.com