[2090edva ver. 09/17] UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF VIRGINIA Division In re: Case No. Chapter Debtor(s) Plaintiff(s) Adversary Proceeding No. v. Defendant(s) CERTIFICATION UNDER LOCAL BANKRUPTCY RULE 2090-1 Document Title: Date Document Filed: Docket Entry No. I declare under penalty of perjury that (Check one box): No attorney has prepared or assisted in the preparation of this document. The following attorney prepared or assisted in the preparation of this document. (Name of Attorney) (Address of Attorney) (Telephone Number of Attorney) Name of Pro Se Party (Print or Type) Name of Pro Se Party (Print or Type) Signature of Pro Se Party Signature of Pro Se Party Executed on: (Date) American LegalNet, Inc. www.FormsWorkFlow.com