UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH In re: _________________________ _________________________ Debtor(s). Case No. ______________ Chapter _____ Trustee: ___________________ AMENDMENT DECLARATION Please circle or underline amended material when appropriate. 1. PETITION: _____ REOPENING: Yes ____ No ____ CONVERSION (13 to 7): Yes ____ No ____ When changing debtor's address, please file separate change of address form. When amending, please submit the changes/additions only! 2. SCHEDULES: A____ B____ C____ D____ E____ F____ G____ H____ I____ J____ Are you changing the address, amounts, etc., or adding a creditor? Changing ___ Adding ___ ($30 amendment fee required for D, E, & F; OR ____ IFP Waiver) AMENDED AMOUNTS/TOTALS OF SCHEDULES: ____ STATEMENT OF AFFAIRS: ____ AMENDED CHAPTER 13 PLAN: ___ If you have amended schedules D, E, F by adding a creditor, you owe $30.00 amendment fee. Fee attached____________ If schedules D, E, F were amended but no creditors added or adding a listed creditor's attorney, no fee necessary. No fee attached_____ Reason no fee is attached_______________________________________________ It is the debtor's responsibility to notify additional creditors by sending a 341 notice and/or Discharge Order to the creditors added to the schedules/matrix. A certificate of mailing to creditors should be filed with the Clerk's office (see below). I declare under penalty of perjury that the information provided in this attached amendment is true and correct. ___________________________________ Debtor Date ________________________________ Debtor Date 3. 4. 5. U.S. Trustee's Office and Trustee in the case supplied copies of amendment(s)? Yes ___ No ___ ____________________________________ ATTORNEY FOR DEBTOR(S) CERTIFICATE OF MAILING I hereby certify that a true and correct copy of the foregoing was mailed, postage prepaid, to creditors of this estate as follows (please mark the appropriate lines(s): ____ ____ ____ 341 Notice to creditors added by this amendment. Discharge Notice to creditors added by this amendment. Amended Chapter 13 Plan to all creditors. ____________________________________ ATTORNEY FOR DEBTOR(S) Rev 11/11 _______________ DATED American LegalNet, Inc. www.FormsWorkFlow.com