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V T B F o r m M 0 4 /2018 See Vt. LBR 4002 - 3 UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT In re: , Chapter Debtor (s) . Case # T o : J e f f r e y S . E a t o n , Cl e r k o f C o u r t U n i t e d S t a t e s B a n k r up t cy C o u r t , Di s t r i ct of Vermont P . O . Box 1663 11 Elmwood Avenue, Room 240 Bu r li n g t o n , V e r m on t Sent v i a : ( U.S. mail, e - mail, or hand delivery ) S T A T EM E N T O F C H A N G E O F A DD R E S S A ND / O R T E L E P H O N E N U M B E R A N D / O R O T H E R C O N T A C T I N F O R MA T IO N I n c o m pl i an c e w i t h F e d e r a l B a n k r u p t c y R ul e 4 0 0 2 an d V t . L BR 4 0 0 2 - 3 , p l ea s e m a k e n o t e o f t h e f o ll o w i n g c h a ng e ( s ) i n c o n t a c t i n f o r m a t i o n f o r [ name of party filing this form ] . N a m e : Role in Case: M ai l i n g A d d r e ss : C i t y : S t a t e : Z ip : T e l e ph o n e N o : E - mail Address: O t h e r New C on t a c t I n f o rmation: T hi s c h a ng e i n c on t a c t i n f o r m a t i o n i s e f f e c t i v e as of [ date ] Respectfully submitted, Dated: By: [ Signature ] [ printed name, with address, e - mail address, and telephone number ] American LegalNet, Inc. www.FormsWorkFlow.com
