Declaration Concerning Debtor's Schedules (United States)
This is a supplemental form to a Bankruptcy and is a declaration of a debtor's schedules. The form provided here is simply a sample of what the actual Form B6 looks like.
In re _________________________________________ Debtor,
Case No. ______________________________ (If known)
DECLARATION CONCERNING DEBTOR'S SCHEDULES
DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR
I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of
_________________________________________ (total shown on summary page plus 1) sheets, and that they are true and correct to the best of my knowledge, information, and belief.
Signature: ______________________________ Debtor
Signature: ______________________________ (Joint Debtor, if any)
[If joint case, both spouses must sign.]
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. _________________________________
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.
Signature of Bankruptcy Petition Preparer
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.
DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF A CORPORATION OR PARTNERSHIP
I, the __________________________________ [the president or other officer or an authorized agent of the corporation or a member or an authorized agent of the partnership]
of the ___________________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and schedules,
consisting of _______________________________________________ sheets, and that they are true and correct to the best of my knowledge, information, and belief. (Total shown on summary page plus 1.)
[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]