UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA Division In re Case No. Debtor(s) Chapter 7 CERTIFICATE AND AFFIDAVIT FOR ADDING CREDITORS TO SCHEDULES IN A CLOSED CASE 1. The undersigned pro se debtor(s) or the undersigned member of the bar of this Court, who represents the debtor(s) herein, hereby certifies that: a. The above-captioned case was filed under or converted to Chapter 7 of the Bankruptcy Code ("Chapter 7") and remained a case under Chapter 7 until closing; b. After filing under or conversion to Chapter 7, a notice of no dividend, contained in the notice of the first meeting of creditors, was sent to creditors listed on the schedules, informing them that they need not file claims in the above-captioned case; c. The Chapter 7 Trustee has filed a report of no distribution and since that filing no further assets of the estate have been administered; and d. The purpose of filing this Certificate is to amend the schedules to add only the pre-petition creditor(s) listed on the attached sheet. In addition, due notice has been sent to such creditor(s), and no response has been received by the debtor(s) within the thirty (30) day notice period. 2. That the debtor(s) signing below, under penalty of perjury, further certifies that: a. Such debtor(s) did not intentionally omit the creditor(s) listed on the attached sheet from the schedules filed in the above-captioned case; and b. Such debtor(s) did not intend to hinder, delay or defraud said creditor(s). COUNSEL FOR DEBTOR(S) (Signature) (Printed Name) Debtor Joint Debtor Dated: [ver. 10/0l/94] (Typed Name(s)) American LegalNet, Inc. www.USCourtForms.com