Certification And Signature Of Non-Attorney Bankruptcy Petition Preparer (United States)
This is certification of a non-attorney bankruptcy preparer and a supplement to a bankruptcy form. The form provided here is simply a sample of what the actual Form B19 looks like.
Form B19
12/94
Form 19. CERTIFICATION AND SIGNATURE OF NON-ATTORNEY
BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)
[Caption as in Form 16B.]
CERTIFICATION AND SIGNATURE OF NON-ATTORNEY
BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)
I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document.
_____________________________________________________
Printed or Typed Name of Bankruptcy Petition Preparer
_____________________________________________________
Social Security No.
_____________________________________________________
_____________________________________________________
Address
Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document:
_____________________________________________________
_____________________________________________________
If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.
X _______________________________________________
Signature of Bankruptcy Petition Preparer
_____________________________________________________
Date
A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.